Provider Demographics
NPI:1275988057
Name:SCHOTT, NICOLE (AGNP-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:SCHOTT
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6455 LA JOLLA BLVD
Mailing Address - Street 2:UNIT 136
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-6627
Mailing Address - Country:US
Mailing Address - Phone:314-401-5342
Mailing Address - Fax:
Practice Address - Street 1:440 STEVENS AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-2057
Practice Address - Country:US
Practice Address - Phone:888-660-4425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004230363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner