Provider Demographics
NPI:1013565191
Name:DRISCOLL, NIKOLA
Entity type:Individual
Prefix:
First Name:NIKOLA
Middle Name:
Last Name:DRISCOLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 NORTH HALSTED ST
Mailing Address - Street 2:101
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:41 N WESTGATE RD
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-2254
Practice Address - Country:US
Practice Address - Phone:773-899-0483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-31
Last Update Date:2025-08-06
Deactivation Date:2025-04-22
Deactivation Code:
Reactivation Date:2025-07-28
Provider Licenses
StateLicense IDTaxonomies
IL209032215363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily