Provider Demographics
NPI:1750892105
Name:SAGE, NICOLE DEANN (PNP)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:DEANN
Last Name:SAGE
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W STATE HIGHWAY 6 STE 102
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-5592
Mailing Address - Country:US
Mailing Address - Phone:254-399-8364
Mailing Address - Fax:
Practice Address - Street 1:601 W STATE HIGHWAY 6 STE 102
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-5592
Practice Address - Country:US
Practice Address - Phone:254-399-8364
Practice Address - Fax:254-399-9116
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135426363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics