Provider Demographics
NPI:1851777619
Name:DAVIS, NICOLE (APN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 N RANDALL RD STE 260
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-9402
Mailing Address - Country:US
Mailing Address - Phone:847-931-7900
Mailing Address - Fax:
Practice Address - Street 1:1710 N RANDALL RD STE 260
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-9402
Practice Address - Country:US
Practice Address - Phone:847-931-7900
Practice Address - Fax:847-931-1562
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012841363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care