Provider Demographics
NPI:1336833672
Name:TAGLIAVENTO, NICHOLE LEE (APRN)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:LEE
Last Name:TAGLIAVENTO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MARKET ST APT A24
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1899
Mailing Address - Country:US
Mailing Address - Phone:781-572-1272
Mailing Address - Fax:
Practice Address - Street 1:155 MAIN DUNSTABLE RD STE 200
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3640
Practice Address - Country:US
Practice Address - Phone:603-484-6694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH093301-23363LP0808X, 2083A0300X, 363LA2200X
MARN2309030363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health