Provider Demographics
NPI:1912650987
Name:SIMENTAL, NICOLE LYNN (RN- BSN FNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNN
Last Name:SIMENTAL
Suffix:
Gender:F
Credentials:RN- BSN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3637 SAN PEDRO CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4916
Mailing Address - Country:US
Mailing Address - Phone:623-759-5751
Mailing Address - Fax:
Practice Address - Street 1:2 JAMES WAY STE 209
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-4976
Practice Address - Country:US
Practice Address - Phone:805-549-6915
Practice Address - Fax:805-549-6916
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-31
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COF06212007363LF0000X
CA95029443363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily