Provider Demographics
NPI:1588918825
Name:NICOLSON, NANCY (ANP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:NICOLSON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PIDGEON HILL DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:21065
Mailing Address - Country:US
Mailing Address - Phone:703-539-6029
Mailing Address - Fax:571-612-8894
Practice Address - Street 1:237 FAIRVIEW ST NW
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175
Practice Address - Country:US
Practice Address - Phone:703-777-9300
Practice Address - Fax:703-258-0714
Is Sole Proprietor?:No
Enumeration Date:2012-11-08
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170193363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health