Provider Demographics
NPI:1831781772
Name:TRICOLICI, ELEONORA (FNP-BC)
Entity type:Individual
Prefix:
First Name:ELEONORA
Middle Name:
Last Name:TRICOLICI
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4337 MARSHALL RD
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5141
Mailing Address - Country:US
Mailing Address - Phone:817-637-0851
Mailing Address - Fax:
Practice Address - Street 1:151 N SUNRISE AVE STE 1205
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2932
Practice Address - Country:US
Practice Address - Phone:916-789-1505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95016089363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner