Provider Demographics
NPI:1215966742
Name:ORR, NICOLE B (PA-C)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:B
Last Name:ORR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14428 CORTE LAMPARA
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-3818
Mailing Address - Country:US
Mailing Address - Phone:619-398-2988
Mailing Address - Fax:619-398-2987
Practice Address - Street 1:7525 LINDA VISTA RD
Practice Address - Street 2:SUITE C
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111
Practice Address - Country:US
Practice Address - Phone:619-398-2988
Practice Address - Fax:619-398-2987
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16649363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP90361Medicare UPIN
CAPA16649Medicare ID - Type Unspecified