Provider Demographics
NPI:1225525793
Name:RESTKO, NICOLE LEEANNE (ACNP-BC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LEEANNE
Last Name:RESTKO
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:DARBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP-BC
Mailing Address - Street 1:PO BOX 5730
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-5700
Mailing Address - Country:US
Mailing Address - Phone:888-402-7256
Mailing Address - Fax:
Practice Address - Street 1:5430 FREDERICKSBURG RD STE 400
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3539
Practice Address - Country:US
Practice Address - Phone:210-538-2310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-APN.0102517-C-NP363LA2100X
TX1204986363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care