Provider Demographics
NPI:1477819860
Name:ENTENZA, NICOLE L (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:L
Last Name:ENTENZA
Suffix:
Gender:
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 E HORIZON RIDGE PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-7906
Mailing Address - Country:US
Mailing Address - Phone:702-553-4105
Mailing Address - Fax:
Practice Address - Street 1:2400 N TENAYA WAY STE 131
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0645
Practice Address - Country:US
Practice Address - Phone:702-608-6412
Practice Address - Fax:702-608-9046
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2025-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024669363LP0808X
NV865565363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health