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NPI Code Detail

MEDICARE: NICOLE MARIE PANTIS RN

MEDICARE: NICOLE MARIE PANTIS RN
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
1163W00000XRegistered Nurse712393NY

General Provider Information

NPI Number : 1760254387
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE MARIE PANTIS RN
Provider Business Mailing Address
First Line : 1200 5TH AVE N APT 1304
Second Line :
City : SURFSIDE BEACH
State : SC
Zip : 29575-5925
Country : US
Telephone Number : 845-645-1897
Fax Number :
Provider Business Practice Location Address
First Line : 164 WACCAMAW MEDICAL PARK DR
Second Line :
City : CONWAY
State : SC
Zip : 29526-8903
Country : US
Telephone Number : 843-347-4888
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2023
Last Update Date : 06/09/2026

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