Provider Demographics
NPI:1841582053
Name:LINK, NICOLE A (NP-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:A
Last Name:LINK
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 1:200 SAINT CLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-2400
Mailing Address - Country:US
Mailing Address - Phone:419-300-1129
Mailing Address - Fax:419-394-0255
Practice Address - Street 1:1140 S KNOXVILLE AVE STE A
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:OH
Practice Address - Zip Code:45885-2609
Practice Address - Country:US
Practice Address - Phone:419-394-9959
Practice Address - Fax:419-394-0255
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH347337163W00000X
OHAPRN.CNP.12427363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1184652539OtherGROUP NPI
OH9934723OtherGROUP MEDICARE PTAN
OH0052241Medicaid