Healthcare Provider Details

I. General information

NPI: 1780650036
Provider Name (Legal Business Name): HOLLY N NICHOLS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4045 E BELL RD STE 125
PHOENIX AZ
85032-2238
US

IV. Provider business mailing address

4045 E BELL RD STE 125
PHOENIX AZ
85032-2238
US

V. Phone/Fax

Practice location:
  • Phone: 602-971-0268
  • Fax: 602-971-1556
Mailing address:
  • Phone: 602-971-0268
  • Fax: 602-971-1556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number22657
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number45627
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number45627
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP7482
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: