Healthcare Provider Details

I. General information

NPI: 1073574513
Provider Name (Legal Business Name): NICHOLAS JAMES TOLENTINO APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MEMBERS WAY FL 5
DOVER NH
03820-5933
US

IV. Provider business mailing address

789 CENTRAL AVE
DOVER NH
03820-2526
US

V. Phone/Fax

Practice location:
  • Phone: 603-609-6800
  • Fax: 603-609-6820
Mailing address:
  • Phone: 603-609-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number068483-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: