Healthcare Provider Details

I. General information

NPI: 1184376758
Provider Name (Legal Business Name): NICOLE SBROCCHI CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1574 HENTHORNE DR STE C
MAUMEE OH
43537-3921
US

IV. Provider business mailing address

1574 HENTHORNE DR STE C
MAUMEE OH
43537-3921
US

V. Phone/Fax

Practice location:
  • Phone: 419-517-1737
  • Fax: 419-517-0801
Mailing address:
  • Phone: 419-517-1737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0030629
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-01647
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: