Healthcare Provider Details

I. General information

NPI: 1811662810
Provider Name (Legal Business Name): NICOLETTE CAROLYN SERRATORE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8835 GERMANTOWN AVE
PHILADELPHIA PA
19118-2718
US

IV. Provider business mailing address

3324 FISHER RD
LANSDALE PA
19446-5720
US

V. Phone/Fax

Practice location:
  • Phone: 215-248-8200
  • Fax:
Mailing address:
  • Phone: 215-688-7906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9120925
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberMA063881
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: