Provider Demographics
NPI:1699053959
Name:NIXON, YOLANDA H (CRNP)
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:H
Last Name:NIXON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:YOLANDA
Other - Middle Name:
Other - Last Name:HUERTAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:3400 CIVIC CENTER BLVD
Mailing Address - Street 2:SUITE EAST PAVILION 2ND FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5127
Mailing Address - Country:US
Mailing Address - Phone:215-456-7890
Mailing Address - Fax:215-254-2599
Practice Address - Street 1:3400 CIVIC CENTER BLVD
Practice Address - Street 2:SUITE EAST PAVILION 2ND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5127
Practice Address - Country:US
Practice Address - Phone:215-456-7890
Practice Address - Fax:215-456-2482
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009786363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
231866Medicare PIN