Provider Demographics
NPI:1265864268
Name:NEWCOMB, NICOLE KATHLEEN (PA-C, ASW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:KATHLEEN
Last Name:NEWCOMB
Suffix:
Gender:F
Credentials:PA-C, ASW
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:KATHOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:10790 RANCHO BERNARDO RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-5705
Mailing Address - Country:US
Mailing Address - Phone:858-605-7171
Mailing Address - Fax:
Practice Address - Street 1:278 TOWN CENTER PKWY
Practice Address - Street 2:STE 105 (S90)
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-5800
Practice Address - Country:US
Practice Address - Phone:619-713-7880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW62470101YM0800X
CAPA56882363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health