MEDICARE: MS. NICOLE RICCIARDI APN, MS, CPNP-PC

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	363L00000X	Nurse Practitioner	26NJ01394800	NJ
2	363LP0200X	Pediatric Nurse Practitioner	26NJ01394800	NJ
3	363LP0200X	Pediatric Nurse Practitioner	F383396-01	NY

General Provider Information

NPI Number	:	1598483901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NICOLE RICCIARDI APN, MS, CPNP-PC

Provider Business Mailing Address
First Line	:	401 ROUTE 73 N STE 320
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053-3426
Country	:	US
Telephone Number	:	201-585-7337
Fax Number	:

Provider Business Practice Location Address
First Line	:	2175 LEMOINE AVE # 502
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-6008
Country	:	US
Telephone Number	:	201-585-7337
Fax Number	:

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

Provider Enumeration Date	:	08/22/2022
Last Update Date	:	06/02/2026

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