Provider Demographics
NPI:1578361671
Name:DYCUS, NICOLE (CPNP-PC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:DYCUS
Suffix:
Gender:
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 ALCOVY ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-2139
Mailing Address - Country:US
Mailing Address - Phone:770-207-7916
Mailing Address - Fax:855-449-2597
Practice Address - Street 1:311 ALCOVY ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2139
Practice Address - Country:US
Practice Address - Phone:770-207-7916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN323955363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics