MEDICARE: MRS. NICOLE DYAN CHAVEZ FNP-C

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	69419	NM

General Provider Information

NPI Number	:	1265150866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE DYAN CHAVEZ FNP-C

Provider Business Mailing Address
First Line	:	3113 NATIONAL PARKS HWY STE 3
Second Line	:
City	:	CARLSBAD
State	:	NM
Zip	:	88220-5697
Country	:	US
Telephone Number	:	575-988-9511
Fax Number	:	575-988-9520

Provider Business Practice Location Address
First Line	:	3113 NATIONAL PARKS HWY STE 3
Second Line	:
City	:	CARLSBAD
State	:	NM
Zip	:	88220-5697
Country	:	US
Telephone Number	:	575-988-9511
Fax Number	:	575-988-9520

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

Provider Enumeration Date	:	08/19/2022
Last Update Date	:	04/07/2026

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