Provider Demographics
NPI:1497369334
Name:GIN, NICOLE DIANE BURCA (NP)
Entity Type:Individual
Prefix:
First Name:NICOLE DIANE
Middle Name:BURCA
Last Name:GIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6423
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-6423
Mailing Address - Country:US
Mailing Address - Phone:480-981-1326
Mailing Address - Fax:480-981-1445
Practice Address - Street 1:6111 E ARBOR AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-6059
Practice Address - Country:US
Practice Address - Phone:480-981-1326
Practice Address - Fax:480-981-1445
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ227588363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty