Healthcare Provider Details

I. General information

NPI: 1871430595
Provider Name (Legal Business Name): NICHOLA COLEMAN CEPHAS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4518 SNYDER AVE
BROOKLYN NY
11203-4114
US

IV. Provider business mailing address

4518 SNYDER AVE
BROOKLYN NY
11203-4114
US

V. Phone/Fax

Practice location:
  • Phone: 910-538-0180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberF358982-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: