Provider Demographics
NPI:1043536808
Name:BARON, NICOLE VANESSA (PNP)
Entity type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:VANESSA
Last Name:BARON
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:170 CLINTON ST
Mailing Address - Street 2:APARTMENT 7
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4623
Mailing Address - Country:US
Mailing Address - Phone:917-699-7890
Mailing Address - Fax:
Practice Address - Street 1:630 W 168TH ST
Practice Address - Street 2:PH 17
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3725
Practice Address - Country:US
Practice Address - Phone:212-305-5903
Practice Address - Fax:212-342-5756
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF382120-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics