Provider Demographics
NPI:1689027542
Name:RAYTA, NICOLE LYNN (APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:LYNN
Last Name:RAYTA
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 PROVIDENCE ST
Mailing Address - Street 2:
Mailing Address - City:WEST WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02893-2508
Mailing Address - Country:US
Mailing Address - Phone:401-615-2800
Mailing Address - Fax:401-651-2805
Practice Address - Street 1:10 DORRANCE ST STE 700
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-2014
Practice Address - Country:US
Practice Address - Phone:833-229-0957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP181041363LF0000X
NY342800363LF0000X
RIAPRN01407363LF0000X
NH077384-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily