Provider Demographics
NPI:1457794166
Name:CONIGLIO, NICOLE (ACNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:CONIGLIO
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3593 MEDINA RD # 181
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-8182
Mailing Address - Country:US
Mailing Address - Phone:330-416-2787
Mailing Address - Fax:866-519-5293
Practice Address - Street 1:3593 MEDINA RD # 181
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-8182
Practice Address - Country:US
Practice Address - Phone:330-416-2787
Practice Address - Fax:866-519-5293
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13892363LA2100X
OHCOA.13892-NP364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care