Provider Demographics
NPI:1942066105
Name:FLORENTINE, NICKCOLIS (AGACNP)
Entity Type:Individual
Prefix:
First Name:NICKCOLIS
Middle Name:
Last Name:FLORENTINE
Suffix:
Gender:M
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4026 MEADOWICK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-7841
Mailing Address - Country:US
Mailing Address - Phone:614-216-3838
Mailing Address - Fax:
Practice Address - Street 1:4026 MEADOWICK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-7841
Practice Address - Country:US
Practice Address - Phone:614-216-3838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0035337363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care