Provider Demographics
NPI:1598432585
Name:NIKOLOVA, BORIANA ROUSSEVA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:BORIANA
Middle Name:ROUSSEVA
Last Name:NIKOLOVA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3608 W KATHLEEN RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-7648
Mailing Address - Country:US
Mailing Address - Phone:480-304-2239
Mailing Address - Fax:
Practice Address - Street 1:17487 S HEALTHCARE DR
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-8500
Practice Address - Country:US
Practice Address - Phone:520-550-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261942363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily