Provider Demographics
NPI:1215932306
Name:OPREA, NICOLE F (PA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:F
Last Name:OPREA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6965 W AIRE LIBRE AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-3987
Mailing Address - Country:US
Mailing Address - Phone:602-758-5230
Mailing Address - Fax:623-251-2851
Practice Address - Street 1:6965 W AIRE LIBRE AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3987
Practice Address - Country:US
Practice Address - Phone:602-758-5230
Practice Address - Fax:623-251-2851
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2627363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00193604OtherRAIL ROAD
P00193604OtherRAILROAD
AZ899213Medicaid
AZP00193604OtherRAIL ROAD
AZ100401Medicare ID - Type Unspecified