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General NPI Number Information
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NPI Number | 1194347922
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Entity Type | Individual
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Provider Name | NICAYLA S POLANCO FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/14/2020
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Last Update Date | 12/03/2023
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Provider Practice Location Address
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Address Line | 1991 FORDHAM DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3773
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Country | US
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Telephone | 910-491-1851
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Fax |
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Provider Business Mailing Address
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Address Line | 108 TEN ACRES TRL
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City | RAEFORD
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State | NC
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Zip | 28376-9672
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Country | US
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Telephone | 910-603-8147
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5013351
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License Number State | NC
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