Provider Demographics
NPI:1952367237
Name:CINCINNATI, NICOLE (CRNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:CINCINNATI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 REED AVENUE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-2029
Mailing Address - Country:US
Mailing Address - Phone:610-376-7365
Mailing Address - Fax:610-376-1320
Practice Address - Street 1:1030 REED AVENUE
Practice Address - Street 2:SUITE 114
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-2029
Practice Address - Country:US
Practice Address - Phone:610-376-7365
Practice Address - Fax:610-376-1320
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2017-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007986363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101355441Medicaid
PA077034GDFMedicare PIN
PA077034Medicare ID - Type Unspecified
PA101355441Medicaid