Provider Demographics
NPI:1023205903
Name:RINCON, NICOLE MICHELLE (PA-C)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:MICHELLE
Last Name:RINCON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:MICHELLE
Other - Last Name:RINCON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:18880 CHERRY VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUOLUMNE
Mailing Address - State:CA
Mailing Address - Zip Code:95379-9506
Mailing Address - Country:US
Mailing Address - Phone:909-732-2570
Mailing Address - Fax:
Practice Address - Street 1:18880 CHERRY VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:TUOLUMNE
Practice Address - State:CA
Practice Address - Zip Code:95379-9506
Practice Address - Country:US
Practice Address - Phone:909-732-2570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19355363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant