Healthcare Provider Details

I. General information

NPI: 1861924516
Provider Name (Legal Business Name): NICOLE MARIE DAISA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 LENNON LN
WALNUT CREEK CA
94598-2443
US

IV. Provider business mailing address

575 LENNON LN
WALNUT CREEK CA
94598-2443
US

V. Phone/Fax

Practice location:
  • Phone: 925-433-8786
  • Fax: 925-433-8788
Mailing address:
  • Phone: 925-433-8786
  • Fax: 925-433-8788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95415429
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60666816
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60782216
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95035040
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: