Provider Demographics
NPI:1942683768
Name:AYALA, NICOLE (MS, FNP-BC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:AYALA
Suffix:
Gender:F
Credentials:MS, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 FROM RD STE 220
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-3551
Mailing Address - Country:US
Mailing Address - Phone:201-342-2550
Mailing Address - Fax:201-342-2550
Practice Address - Street 1:650 FROM RD STE 220
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3551
Practice Address - Country:US
Practice Address - Phone:201-342-2550
Practice Address - Fax:201-342-2550
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF339426363LF0000X
NY634182163W00000X
NJ26NJ01172400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse