Provider Demographics
NPI:1316930084
Name:CICAK, NANCY TAYLOR (CRNP)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:TAYLOR
Last Name:CICAK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 N. COLLEGE ST.
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-2727
Mailing Address - Country:US
Mailing Address - Phone:717-245-1835
Mailing Address - Fax:
Practice Address - Street 1:28 N.COLLEGE ST.
Practice Address - Street 2:DICKINSON COLLEGE HEALTH SERVICES
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-2727
Practice Address - Country:US
Practice Address - Phone:717-245-1835
Practice Address - Fax:717-245-1938
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN227137L163W00000X
PATP000441G363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PATA1515645OtherHIGHMARK BLUE SHIELD