Provider Demographics
NPI:1265736920
Name:NICHOLS, AMY MICHELLE ESTEP (C-PNP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MICHELLE ESTEP
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:C-PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8713 DIGGES RD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4403
Mailing Address - Country:US
Mailing Address - Phone:703-330-9222
Mailing Address - Fax:703-330-4425
Practice Address - Street 1:8713 DIGGES RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4403
Practice Address - Country:US
Practice Address - Phone:703-330-9222
Practice Address - Fax:703-330-4425
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN198801363LP0200X
VA0024179785363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics