Provider Demographics
NPI:1598122087
Name:NICOLOSI, NANCY (NP-C)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:NICOLOSI
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24331 EL TORO RD
Mailing Address - Street 2:SUITE 380
Mailing Address - City:LAGUNA WOODS
Mailing Address - State:CA
Mailing Address - Zip Code:92637-2752
Mailing Address - Country:US
Mailing Address - Phone:949-583-0222
Mailing Address - Fax:
Practice Address - Street 1:24331 EL TORO RD
Practice Address - Street 2:SUITE 380
Practice Address - City:LAGUNA WOODS
Practice Address - State:CA
Practice Address - Zip Code:92637-2752
Practice Address - Country:US
Practice Address - Phone:949-583-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003677363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health