Provider Demographics
NPI:1215706775
Name:AQUILIO, NICOLE (MS, RDN, LDN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:AQUILIO
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 WILSON RD APT 334
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37912-6030
Mailing Address - Country:US
Mailing Address - Phone:513-658-5242
Mailing Address - Fax:
Practice Address - Street 1:2100 WILSON RD APT 334
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37912-6030
Practice Address - Country:US
Practice Address - Phone:513-658-5242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4611133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered