Provider Demographics
NPI:1154885150
Name:PHILLIPS, NICOLE RENEE (APRN-CNP)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:RENEE
Last Name:PHILLIPS
Suffix:
Gender:
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3459 SAINT ROSE PKWY STE 120-411
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4601
Mailing Address - Country:US
Mailing Address - Phone:702-850-1442
Mailing Address - Fax:
Practice Address - Street 1:10620 SOUTHERN HIGHLANDS PKWY STE 110-155
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141-4371
Practice Address - Country:US
Practice Address - Phone:702-754-5421
Practice Address - Fax:775-312-2857
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV816584363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner