Healthcare Provider Details

I. General information

NPI: 1922950773
Provider Name (Legal Business Name): NICOLE ALEXANDRA SISTEK MSN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2026
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3126 S HIGLEY RD STE 104
GILBERT AZ
85295-2030
US

IV. Provider business mailing address

3126 S HIGLEY RD STE 104
GILBERT AZ
85295-2030
US

V. Phone/Fax

Practice location:
  • Phone: 480-719-7400
  • Fax:
Mailing address:
  • Phone: 480-719-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN165204
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-RNP339898
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: