Provider Demographics
NPI:1215081732
Name:NICOSIA, MARY JACQUELINE (RN APN-C)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:JACQUELINE
Last Name:NICOSIA
Suffix:
Gender:F
Credentials:RN APN-C
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Mailing Address - Street 1:126 MANOR DR
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-2461
Mailing Address - Country:US
Mailing Address - Phone:732-687-5321
Mailing Address - Fax:732-212-9030
Practice Address - Street 1:211 SHREWSBURY AVE
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1250
Practice Address - Country:US
Practice Address - Phone:732-212-8442
Practice Address - Fax:732-212-9030
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NY26NO06130700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily