Healthcare Provider Details

I. General information

NPI: 1861280521
Provider Name (Legal Business Name): NICOLE MARIE LYNCH PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COLEY LYNCH

II. Dates (important events)

Enumeration Date: 04/30/2025
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 W AMES CT STE 100
PLAINVIEW NY
11803-2304
US

IV. Provider business mailing address

950 S OYSTER BAY RD
HICKSVILLE NY
11801-3510
US

V. Phone/Fax

Practice location:
  • Phone: 516-704-3262
  • Fax:
Mailing address:
  • Phone: 516-704-3262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number773689
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number408073
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: