Individual
MRS. NICOLE CARRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
377 JERSEY AVE STE 450, JERSEY CITY, NJ 07302-4397
(201) 915-2525
Mailing address
377 JERSEY AVE STE 450, JERSEY CITY, NJ 07302-4397
(201) 915-2525
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
25MP00203400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25MP00203400
LICENSE
NJ
Enumeration date
09/04/2008
Last updated
01/25/2023
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