Healthcare Provider Details

I. General information

NPI: 1114517828
Provider Name (Legal Business Name): NICOLE M DEMASTRY KOLIKOHN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2021
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 GREAT CIRCLE RD
NASHVILLE TN
37228-1317
US

IV. Provider business mailing address

1897 PLEASANTVILLE RD
LANCASTER OH
43130-9348
US

V. Phone/Fax

Practice location:
  • Phone: 615-436-9060
  • Fax: 615-235-9725
Mailing address:
  • Phone: 740-503-5025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0027965
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: