Provider Demographics
NPI:1467999243
Name:FERRONI, NICOLE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:FERRONI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2534 S 18TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-3701
Mailing Address - Country:US
Mailing Address - Phone:215-463-4363
Mailing Address - Fax:215-463-4365
Practice Address - Street 1:2534 S 18TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-3701
Practice Address - Country:US
Practice Address - Phone:215-465-4363
Practice Address - Fax:215-463-4365
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016998363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103286521Medicaid
PA574319OtherMEDICARE