Provider Demographics
NPI:1477529725
Name:NICOLINI, JENNIFER C (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:NICOLINI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 JULIAN LANE
Mailing Address - Street 2:SUITE 630
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704
Mailing Address - Country:US
Mailing Address - Phone:828-651-0121
Mailing Address - Fax:828-651-0141
Practice Address - Street 1:600 JULIAN LN
Practice Address - Street 2:SUITE 630
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-7813
Practice Address - Country:US
Practice Address - Phone:828-651-0121
Practice Address - Fax:828-651-0141
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2004000722207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
01760OtherCOMMERCIAL PRIVATE PAY
P00157233OtherMEDICARE METRAHEALTH
1369EOtherBCBS
891369EOtherCAROLINA ACCESS
NC891369EMedicaid
561565803OtherCIGNA HEALTHCARE OF NC
2307353OtherUHC
P00157233OtherMEDICARE METRAHEALTH
2307353OtherUHC