Provider Demographics
NPI:1639817323
Name:KATZAKIS, NICOLE MARIE (CNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:KATZAKIS
Suffix:
Gender:
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4274 CHAMPLIN DR
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-7176
Mailing Address - Country:US
Mailing Address - Phone:440-527-1663
Mailing Address - Fax:
Practice Address - Street 1:30000 E RIVER RD
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-3429
Practice Address - Country:US
Practice Address - Phone:419-934-3440
Practice Address - Fax:419-661-4020
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH448032363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care