Provider Demographics
NPI:1760074199
Name:PERRUCCI, NICOLE (APN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:PERRUCCI
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:PERRUCCI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN
Mailing Address - Street 1:471 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2102
Mailing Address - Country:US
Mailing Address - Phone:973-635-4635
Mailing Address - Fax:
Practice Address - Street 1:471 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2102
Practice Address - Country:US
Practice Address - Phone:973-635-4635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01096000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily