Provider Demographics
NPI:1710598644
Name:LICATO, NICOLE DORA (DNP, RN, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:DORA
Last Name:LICATO
Suffix:
Gender:F
Credentials:DNP, RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MAYO ST APT A2
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-1532
Mailing Address - Country:US
Mailing Address - Phone:908-902-9580
Mailing Address - Fax:
Practice Address - Street 1:7200 CREEDMOOR RD STE 208
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-1711
Practice Address - Country:US
Practice Address - Phone:919-701-5157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5013426363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily