Healthcare Provider Details

I. General information

NPI: 1184025371
Provider Name (Legal Business Name): NIKOLE ARROTTA TABARACCI ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 E SHERMAN AVE STE 105
COEUR D ALENE ID
83814-5364
US

IV. Provider business mailing address

8382 N WAYNE DR STE 204
HAYDEN ID
83835-6028
US

V. Phone/Fax

Practice location:
  • Phone: 208-444-1218
  • Fax: 208-620-2410
Mailing address:
  • Phone: 208-635-5265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60466098
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: