# MARY JEEN NICOLA

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1407689870
- **Gender:** F
- **Credential:** CRNP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | APRN11034854 | FL | — |
| 363L00000X | Nurse Practitioner | SP030310 | PA | Yes |

## Other

- **Enumeration date:** 08/21/2024
- **Last updated:** 07/22/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1044722540001 | — | PA |
| 01 | — | 850277 | PA BS | PA |
| 01 | — | CA3219 | PALMETTO GBA - RAILROAD MEDICARE | PA |