MEDICARE: NIKOLE ARROTTA TABARACCI ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP60466098	WA

General Provider Information

NPI Number	:	1184025371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKOLE ARROTTA TABARACCI ARNP

Provider Business Mailing Address
First Line	:	8382 N WAYNE DR STE 204
Second Line	:
City	:	HAYDEN
State	:	ID
Zip	:	83835-6028
Country	:	US
Telephone Number	:	208-635-5265
Fax Number	:

Provider Business Practice Location Address
First Line	:	8382 N WAYNE DR STE 204
Second Line	:
City	:	HAYDEN
State	:	ID
Zip	:	83835-6028
Country	:	US
Telephone Number	:	208-635-5265
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2014
Last Update Date	:	11/13/2023

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