Healthcare Provider Details

I. General information

NPI: 1962331934
Provider Name (Legal Business Name): NICOLE TO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 CLIFTON AVE
CINCINNATI OH
45220-2872
US

IV. Provider business mailing address

1024 LEVANT LN
PLANO TX
75094-4553
US

V. Phone/Fax

Practice location:
  • Phone: 513-556-6000
  • Fax:
Mailing address:
  • Phone: 469-442-6252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1122080
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: