Healthcare Provider Details

I. General information

NPI: 1932629862
Provider Name (Legal Business Name): NICOLE A BAISDEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE A JONES NP

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 SOQUEL DR
SOQUEL CA
95073-2427
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 831-888-9410
  • Fax: 831-477-7795
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number423154
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95010228
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: