Provider Demographics
NPI:1164040945
Name:NICOLL, ASHLEE ANN (NP)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEE
Middle Name:ANN
Last Name:NICOLL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1144
Mailing Address - Street 2:
Mailing Address - City:EAGAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85925-1144
Mailing Address - Country:US
Mailing Address - Phone:928-853-8453
Mailing Address - Fax:
Practice Address - Street 1:114 S MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:SPRINGERVILLE
Practice Address - State:AZ
Practice Address - Zip Code:85938-5104
Practice Address - Country:US
Practice Address - Phone:928-333-4368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ241804363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily