Provider Demographics
NPI:1164298840
Name:NICOLA, ASHLEY (CNP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:NICOLA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 E BRAGSTAD DR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-4047
Mailing Address - Country:US
Mailing Address - Phone:605-690-4840
Mailing Address - Fax:
Practice Address - Street 1:600 BILLARS ST
Practice Address - Street 2:
Practice Address - City:SCOTLAND
Practice Address - State:SD
Practice Address - Zip Code:57059-2026
Practice Address - Country:US
Practice Address - Phone:605-583-2226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP003033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily