Provider Demographics
NPI:1427318518
Name:MORETTI, NICOLE ASHLEY (MD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ASHLEY
Last Name:MORETTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2911 MEDICAL ARTS ST STE 2
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-3331
Mailing Address - Country:US
Mailing Address - Phone:512-391-0175
Mailing Address - Fax:512-476-4078
Practice Address - Street 1:2911 MEDICAL ARTS ST STE 2
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-3331
Practice Address - Country:US
Practice Address - Phone:512-391-0175
Practice Address - Fax:512-476-4078
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR4878207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036138421Medicaid
IL036138421Medicaid