| Doctor Name: | NANCY NICOLOSI |
| NPI Number: | 1598122087 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP-C |
| License Number: | 95003677 |
| Business Practice Address: | 24331 El Toro Rd Suite 380 Laguna Woods, CA - 926372752 |
| Business Phone Number: | 9495830222 |
| Business Fax Number: | |
| Mailing Address: | 24331 El Toro Rd, Suite 380 LAGUNA WOODS |
| State: | CA |
| Postal Code: | 926372752 |
| Phone Number: | 9495830222 |
| Fax Number: | |
| NPI Enumeration Date: | 01/28/2016 |
| NPI Last Update Date: | 01/28/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 95003677 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |