Provider Demographics
NPI:1811509714
Name:SAGADRACA, NICO PAULA PEREZ (APRN, MSN, FNP-BC)
Entity type:Individual
Prefix:
First Name:NICO PAULA
Middle Name:PEREZ
Last Name:SAGADRACA
Suffix:
Gender:F
Credentials:APRN, MSN, FNP-BC
Other - Prefix:
Other - First Name:NICO PAULA
Other - Middle Name:LEONCITO
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:847-390-4757
Practice Address - Street 1:1775 DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1143
Practice Address - Country:US
Practice Address - Phone:847-723-6522
Practice Address - Fax:847-696-3394
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.021593363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner