Healthcare Provider Details

I. General information

NPI: 1831723709
Provider Name (Legal Business Name): NICOLE PATRICIA ESPOSTI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE STOUT PA

II. Dates (important events)

Enumeration Date: 02/28/2020
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PLAINSBORO ROAD SUITE 260
PLAINSBORO NJ
08536-1915
US

IV. Provider business mailing address

5 PLAINSBORO ROAD SUITE 260
PLAINSBORO NJ
08536-1915
US

V. Phone/Fax

Practice location:
  • Phone: 609-372-3220
  • Fax:
Mailing address:
  • Phone: 609-372-3220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00576100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: