Provider Demographics
NPI:1790669299
Name:KACIR, NICOLE MARIANNA (DNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIANNA
Last Name:KACIR
Suffix:
Gender:X
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16811 GALLOP DR
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-3909
Mailing Address - Country:US
Mailing Address - Phone:408-710-0469
Mailing Address - Fax:
Practice Address - Street 1:2 UPPER RAGSDALE DR STE B210
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-7851
Practice Address - Country:US
Practice Address - Phone:831-333-0999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95036495363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics