Provider Demographics
NPI:1467978320
Name:OPPENHEIMER, NICOLE E (PA-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:E
Last Name:OPPENHEIMER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14416 W. MEEKER BLVD
Mailing Address - Street 2:STE 301
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375
Mailing Address - Country:US
Mailing Address - Phone:623-876-3880
Mailing Address - Fax:623-285-2710
Practice Address - Street 1:14416 W. MEEKER BLVD
Practice Address - Street 2:STE 301
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375
Practice Address - Country:US
Practice Address - Phone:623-876-3880
Practice Address - Fax:623-285-2710
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6827363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical