Provider Demographics
NPI:1558939488
Name:REINA, NICOLE L (MSN, APN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:L
Last Name:REINA
Suffix:
Gender:F
Credentials:MSN, APN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 WESTGATE DR
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1352
Mailing Address - Country:US
Mailing Address - Phone:973-592-2271
Mailing Address - Fax:
Practice Address - Street 1:76 WESTGATE DR
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1352
Practice Address - Country:US
Practice Address - Phone:973-592-2271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01164700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily