Provider Demographics
NPI:1952586604
Name:HOROWITZ, NICOLLE MARCIA (LPN, RN, NP)
Entity Type:Individual
Prefix:MS
First Name:NICOLLE
Middle Name:MARCIA
Last Name:HOROWITZ
Suffix:
Gender:F
Credentials:LPN, RN, NP
Other - Prefix:MISS
Other - First Name:NICOLLE
Other - Middle Name:MARCIA
Other - Last Name:ALLICOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN, RN
Mailing Address - Street 1:14 CARAMEL CT
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-1007
Mailing Address - Country:US
Mailing Address - Phone:631-368-7363
Mailing Address - Fax:631-368-7363
Practice Address - Street 1:14 CARAMEL CT
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-1007
Practice Address - Country:US
Practice Address - Phone:631-486-6787
Practice Address - Fax:631-486-6787
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY427022-1163W00000X
NY198633-1164W00000X
NYF340181-1363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01226186Medicaid