Provider Demographics
NPI:1043662356
Name:NEILL, NIKOLA MARIE (FNP-C)
Entity type:Individual
Prefix:
First Name:NIKOLA
Middle Name:MARIE
Last Name:NEILL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:NIKOLA
Other - Middle Name:MARIE
Other - Last Name:SCHAFER, LINNENKAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1760 MCCULLOCH BLVD N
Mailing Address - Street 2:STE 100
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-6559
Mailing Address - Country:US
Mailing Address - Phone:928-854-5368
Mailing Address - Fax:928-854-4462
Practice Address - Street 1:1760 MCCULLOCH BLVD N
Practice Address - Street 2:STE 100
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-6559
Practice Address - Country:US
Practice Address - Phone:928-854-5368
Practice Address - Fax:928-854-4462
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8722363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily