Provider Demographics
NPI:1568061398
Name:EBERLINE, NICOLETTE A (DNP-FNP)
Entity type:Individual
Prefix:DR
First Name:NICOLETTE
Middle Name:A
Last Name:EBERLINE
Suffix:
Gender:
Credentials:DNP-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 S RAMPART BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-5735
Mailing Address - Country:US
Mailing Address - Phone:725-222-8260
Mailing Address - Fax:855-741-5953
Practice Address - Street 1:430 S RAMPART BLVD STE 130
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-5735
Practice Address - Country:US
Practice Address - Phone:725-222-8260
Practice Address - Fax:855-741-5953
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID66011363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily