Provider Demographics
NPI:1184968430
Name:NIKOLLA, IRISI (NP)
Entity type:Individual
Prefix:
First Name:IRISI
Middle Name:
Last Name:NIKOLLA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:IRISI
Other - Middle Name:
Other - Last Name:PAPAPAVLLO-NIKOLLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:533 OVINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-1701
Mailing Address - Country:US
Mailing Address - Phone:347-216-7632
Mailing Address - Fax:
Practice Address - Street 1:129 SENECA ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-2333
Practice Address - Country:US
Practice Address - Phone:347-216-7632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY664266163W00000X
NY0000000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse