Provider Demographics
NPI:1205451259
Name:PICCOLO, NADIA (FNP-C)
Entity type:Individual
Prefix:
First Name:NADIA
Middle Name:
Last Name:PICCOLO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27275 HAGGERTY RD STE 500
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-3635
Mailing Address - Country:US
Mailing Address - Phone:248-741-6901
Mailing Address - Fax:254-721-8203
Practice Address - Street 1:620 N PONTIAC TRL
Practice Address - Street 2:
Practice Address - City:WALLED LAKE
Practice Address - State:MI
Practice Address - Zip Code:48390-3448
Practice Address - Country:US
Practice Address - Phone:248-624-4511
Practice Address - Fax:248-624-4408
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704305895363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily