Provider Demographics
NPI:1114788767
Name:DAVIS-MARENCO, NICOLE RENEE (FNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:RENEE
Last Name:DAVIS-MARENCO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:RENEE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8701 CUYAMACA ST
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-4253
Mailing Address - Country:US
Mailing Address - Phone:619-568-8222
Mailing Address - Fax:
Practice Address - Street 1:8701 CUYAMACA ST
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-4253
Practice Address - Country:US
Practice Address - Phone:619-568-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028700363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care