MEDICARE: NICOLE L. ENTENZA APRN, PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	10047025	OR
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95024669	CA
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	865565	NV

General Provider Information

NPI Number	:	1477819860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE L. ENTENZA APRN, PMHNP-BC

Provider Business Mailing Address
First Line	:	35 E HORIZON RIDGE PKWY STE 110-403
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89002-7905
Country	:	US
Telephone Number	:	702-553-4105
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 N TENAYA WAY STE 131
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0645
Country	:	US
Telephone Number	:	702-608-6403
Fax Number	:	702-608-9046

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

Provider Enumeration Date	:	04/10/2012
Last Update Date	:	12/24/2025

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