Healthcare Provider Details

I. General information

NPI: 1689402372
Provider Name (Legal Business Name): NICOLE MARQUES RICO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 N MAIN ST STE 306
FALL RIVER MA
02720-2972
US

IV. Provider business mailing address

12 WINTER ST
FAIRHAVEN MA
02719-4924
US

V. Phone/Fax

Practice location:
  • Phone: 508-973-9500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2333595
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: