MEDICARE: DIANA SANCHEZ-NICOLAS

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	363LA2200X	Adult Health Nurse Practitioner	5023432	NC
2	363L00000X	Nurse Practitioner	5023432	NC

General Provider Information

NPI Number	:	1881554913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA SANCHEZ-NICOLAS

Provider Business Mailing Address
First Line	:	15806 BROOKWAY DR STE 400
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-3247
Country	:	US
Telephone Number	:	704-766-1000
Fax Number	:	704-766-1002

Provider Business Practice Location Address
First Line	:	15806 BROOKWAY DR STE 400
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-3247
Country	:	US
Telephone Number	:	704-766-1000
Fax Number	:

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

Provider Enumeration Date	:	11/12/2025
Last Update Date	:	06/08/2026

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