MEDICARE: MRS. NICOLE ANNE NEWMAN RN, NNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LN0000X	Neonatal Nurse Practitioner	C-APN.0001293-C-NP	CO
2	363LN0005X	Critical Care Neonatal Nurse Practitioner	AP1525	AZ
3	363LN0005X	Critical Care Neonatal Nurse Practitioner	C-APN.0001293-C-NP	CO
4	163W00000X	Registered Nurse	RN101329	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	701822	OTHER	AZ	AHCCCS

General Provider Information

NPI Number	:	1578513966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE ANNE NEWMAN RN, NNP

Provider Business Mailing Address
First Line	:	3390 E HORSESHOE DR
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85249-5923
Country	:	US
Telephone Number	:	480-883-8745
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 E WILLETTA ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2727
Country	:	US
Telephone Number	:	602-239-5166
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	02/09/2026

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