Provider Demographics
NPI:1992504187
Name:MENDOZA, NICOLE CAMPODONICO (FNP-C)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:CAMPODONICO
Last Name:MENDOZA
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10885 GENITO SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-3688
Mailing Address - Country:US
Mailing Address - Phone:703-819-9458
Mailing Address - Fax:
Practice Address - Street 1:108 COWARDIN AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-2020
Practice Address - Country:US
Practice Address - Phone:804-655-2794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024192604363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily