Individual
NICOLE ROSE DEPADOVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
35 BEAVERSON BLVD STE 9B, BRICK, NJ 08723-7862
(817) 300-1934
Mailing address
404 5TH AVE APT 306, ASBURY PARK, NJ 07712-5462
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
35MP00804400
NJ
Other
Enumeration date
08/23/2023
Last updated
08/29/2023
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