Provider Demographics
NPI:1316338809
Name:SREDNICKI, NICOLE (FNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:SREDNICKI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8679 E VIA DEL PALACIO
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-3915
Mailing Address - Country:US
Mailing Address - Phone:480-620-2399
Mailing Address - Fax:
Practice Address - Street 1:8300 N HAYDEN RD STE A-207
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-2482
Practice Address - Country:US
Practice Address - Phone:480-620-2399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339375363LF0000X
AZAP7801363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily