Provider Demographics
NPI:1093505026
Name:EMMERICH, NICOLE (PMHNP-BC)
Entity type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:
Last Name:EMMERICH
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7692 S MEADOW SPRING WAY
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-5654
Mailing Address - Country:US
Mailing Address - Phone:520-907-2530
Mailing Address - Fax:
Practice Address - Street 1:7692 S MEADOW SPRING WAY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-5654
Practice Address - Country:US
Practice Address - Phone:520-907-2530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ323361363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health