Provider Demographics
NPI: | 1467933671 |
---|---|
Name: | STARKS, NICOLE RENEA (APRN, CNP) |
Entity Type: | Individual |
Prefix: | MRS |
First Name: | NICOLE |
Middle Name: | RENEA |
Last Name: | STARKS |
Suffix: | |
Gender: | F |
Credentials: | APRN, CNP |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 615 ELSINORE PL STE 200 |
Mailing Address - Street 2: | |
Mailing Address - City: | CINCINNATI |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 45202-1457 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 513-834-7063 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 974 N 21ST ST |
Practice Address - Street 2: | |
Practice Address - City: | NEWARK |
Practice Address - State: | OH |
Practice Address - Zip Code: | 43055-2990 |
Practice Address - Country: | US |
Practice Address - Phone: | 740-899-4155 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2018-08-25 |
Last Update Date: | 2021-07-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | RN.341978 | 163W00000X |
OH | APRN.CNP.025255 | 363LA2200X |
OH | APRN.CNP.036366 | 363L00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | |
No | 163W00000X | Nursing Service Providers | Registered Nurse | |
No | 363LA2200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |