Provider Demographics
NPI:1235492604
Name:TIVOLI, NICOLE (MASTERS)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:TIVOLI
Suffix:
Gender:F
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 JESTER LN
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-5218
Mailing Address - Country:US
Mailing Address - Phone:917-617-9380
Mailing Address - Fax:
Practice Address - Street 1:58 JESTER LN
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-5218
Practice Address - Country:US
Practice Address - Phone:917-617-9380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY80466174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist