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General NPI Number Information
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NPI Number | 1790259810
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Entity Type | Individual
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Provider Name | GINA NICOLAS NP
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Gender | Female
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Dates
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Enumeration Date | 01/11/2019
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 46 FRANCINE AVE
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City | MASSAPEQUA
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State | NY
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Zip | 11758-3613
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Country | US
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Telephone | 516-809-5818
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Fax |
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Provider Business Mailing Address
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Address Line | 46 FRANCINE AVE
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City | MASSAPEQUA
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State | NY
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Zip | 11758-3613
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Country | US
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Telephone | 516-809-5818
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | F343470-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 343470
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License Number State | NY
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