Provider Demographics
NPI:1447847835
Name:RICKARD, NICOLE DIANE (DNP, FNP-C)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:DIANE
Last Name:RICKARD
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:DIANE
Other - Last Name:RICKARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1011 W BALTIMORE PIKE STE 304
Mailing Address - Street 2:
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-9448
Mailing Address - Country:US
Mailing Address - Phone:610-869-1278
Mailing Address - Fax:610-869-2312
Practice Address - Street 1:1011 W BALTIMORE PIKE STE 304
Practice Address - Street 2:
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9448
Practice Address - Country:US
Practice Address - Phone:610-869-1278
Practice Address - Fax:610-869-2312
Is Sole Proprietor?:No
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022774363LF0000X
PARN675705163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse