MEDICARE: MS. CONNIE NIKOLAIDIS NP

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	RN081679	AZ
2	163W00000X	Registered Nurse	RN081679	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285615377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CONNIE NIKOLAIDIS NP

Provider Business Mailing Address
First Line	:	6565 E CARONDELET DR
Second Line	:	#235
City	:	TUCSON
State	:	AZ
Zip	:	85710-3533
Country	:	US
Telephone Number	:	520-296-5500
Fax Number	:	520-296-5800

Provider Business Practice Location Address
First Line	:	3501 S 6TH AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85723-3533
Country	:	US
Telephone Number	:	520-792-1450
Fax Number	:

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	12/20/2022

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