MEDICARE: MS. NICOLE SIMONE APN

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	363LG0600X	Gerontology Nurse Practitioner	95034782	CA
2	363LG0600X	Gerontology Nurse Practitioner	26NJ00495800	NJ
3	363LG0600X	Gerontology Nurse Practitioner	234602	AR
4	363LG0600X	Gerontology Nurse Practitioner	114111-23	NH

General Provider Information

NPI Number	:	1285046284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NICOLE SIMONE APN

Provider Business Mailing Address
First Line	:	885 3RD AVE FL 28
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-4834
Country	:	US
Telephone Number	:	305-771-4986
Fax Number	:

Provider Business Practice Location Address
First Line	:	885 3RD AVE FL 28
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-4834
Country	:	US
Telephone Number	:	305-771-4986
Fax Number	:

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

Provider Enumeration Date	:	05/24/2014
Last Update Date	:	02/09/2026

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