Healthcare Provider Details

I. General information

NPI: 1972889566
Provider Name (Legal Business Name): NICOLE M GRASSO REHMAN MSN, APRN, ANP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 W PROSPER TRL STE 210
PROSPER TX
75078-3743
US

IV. Provider business mailing address

1630 W PROSPER TRL STE 210
PROSPER TX
75078-3743
US

V. Phone/Fax

Practice location:
  • Phone: 469-739-1714
  • Fax:
Mailing address:
  • Phone: 469-739-1714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1076810
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number305803
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: