Healthcare Provider Details

I. General information

NPI: 1437620986
Provider Name (Legal Business Name): NICOLE AZAAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2018
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 GUM BRANCH RD APT 405
JACKSONVILLE NC
28540-4601
US

IV. Provider business mailing address

2015 COUNTRYMENS CT UNIT 51
CHARLOTTE NC
28210-6691
US

V. Phone/Fax

Practice location:
  • Phone: 646-450-1448
  • Fax: 208-978-5210
Mailing address:
  • Phone: 646-450-1448
  • Fax: 208-978-5210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberAP-ETMD-2026-FA9CCS
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License NumberAP-FMMD-2026-IC3W4T
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License NumberAP-FMCC-2026-D21Z3N
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberVA-CBCP-2022-NA
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code1744G0900X
TaxonomyGraphics Designer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: