Provider Demographics
NPI:1265968275
Name:VALLECORSA, NICOLE ANDREA (FNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANDREA
Last Name:VALLECORSA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:ANDREA
Other - Middle Name:NICOLE
Other - Last Name:WARSH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:360 US HIGHWAY 1 BYP UNIT 102
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7105
Mailing Address - Country:US
Mailing Address - Phone:603-410-6700
Mailing Address - Fax:808-934-0153
Practice Address - Street 1:18 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6869
Practice Address - Country:US
Practice Address - Phone:207-607-5270
Practice Address - Fax:207-607-5271
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2255363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily