Healthcare Provider Details

I. General information

NPI: 1134080096
Provider Name (Legal Business Name): NICOLE PAIGE SGOUROS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 GROVE AVE STE E
WEST DEPTFORD NJ
08086-2139
US

IV. Provider business mailing address

31 COUNTRY CLUB RD
PINE HILL NJ
08021-6506
US

V. Phone/Fax

Practice location:
  • Phone: 856-900-0041
  • Fax: 856-900-0042
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ15467200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15467200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: