Provider Demographics
NPI:1053689778
Name:ZIMMERMAN, NICOLE A (MSN,RN,NNP-BC)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:A
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:MSN,RN,NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2772 HIMELRIGH BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203
Mailing Address - Country:US
Mailing Address - Phone:330-322-2993
Mailing Address - Fax:
Practice Address - Street 1:2772 HIMELRIGH BLVD
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:OH
Practice Address - Zip Code:44203-3938
Practice Address - Country:US
Practice Address - Phone:330-322-2993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.348163-163W00000X
OHCOA.13258-NP363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No163W00000XNursing Service ProvidersRegistered Nurse