Provider Demographics
NPI:1265194559
Name:ONGTAWCO, NICOLE KRISTINA (NP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:KRISTINA
Last Name:ONGTAWCO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 GILES CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-3314
Mailing Address - Country:US
Mailing Address - Phone:757-401-8844
Mailing Address - Fax:
Practice Address - Street 1:4374 NEW TOWN AVE STE 200
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2865
Practice Address - Country:US
Practice Address - Phone:757-984-6110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024182715363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care