Provider Demographics
NPI:1508131426
Name:NICOSIA, JOLEEN PATRICE (PTA)
Entity Type:Individual
Prefix:
First Name:JOLEEN
Middle Name:PATRICE
Last Name:NICOSIA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6017 HOPE LN
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-9417
Mailing Address - Country:US
Mailing Address - Phone:919-753-3531
Mailing Address - Fax:
Practice Address - Street 1:1995 E. CORNELIUS HARNETT BLVD
Practice Address - Street 2:UNIVERSAL HEALTHCARE OF LILLINGTON
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546
Practice Address - Country:US
Practice Address - Phone:919-753-3531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-09
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3377225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant