Provider Demographics
NPI:1285678821
Name:BARTUCCI, NICOLE (APN, DC,)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:BARTUCCI
Suffix:
Gender:F
Credentials:APN, DC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MELANIE WAY
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2158
Mailing Address - Country:US
Mailing Address - Phone:609-713-0232
Mailing Address - Fax:609-597-5566
Practice Address - Street 1:10 MELANIE WAY
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050
Practice Address - Country:US
Practice Address - Phone:609-713-0232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00549600111N00000X
NJ26NJ00834400363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU89448Medicare UPIN
NJ033870Medicare ID - Type Unspecified