Provider Demographics
NPI:1154968659
Name:GUERRERO, NICOLETTE (CPNP-PC)
Entity type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:
Last Name:GUERRERO
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 AVIARA PKWY # 131747
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-5129
Mailing Address - Country:US
Mailing Address - Phone:619-350-6290
Mailing Address - Fax:
Practice Address - Street 1:1700 AVIARA PKWY # 131747
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-5129
Practice Address - Country:US
Practice Address - Phone:619-350-6290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGAA-NP000323363LP0200X
AL3-001134363LP0200X
TX1053504363LP0200X
AK21409363LP0200X
IL209023909363LP0200X
AZ286619363LP0200X
AR14358363LP0200X
CA95023236363LP0200X
CT11543363LP0200X
DC500007545363LP0200X
FLTPAN1435363LP0200X
NY383377363LP0200X
TN33096363LP0200X
CO0996871363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics