Provider Demographics
NPI:1750403903
Name:NICOLINI, DENISE ANNE (RN, FNP)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:ANNE
Last Name:NICOLINI
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 GUZZI LN C
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5292
Mailing Address - Country:US
Mailing Address - Phone:209-533-0333
Mailing Address - Fax:209-533-0782
Practice Address - Street 1:690 GUZZI LN C
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5292
Practice Address - Country:US
Practice Address - Phone:209-533-0333
Practice Address - Fax:209-533-0782
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA308988363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily