Provider Demographics
NPI:1538592936
Name:TSOUKALAS, NICOLE MARIE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MARIE
Last Name:TSOUKALAS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:MARIE
Other - Last Name:SPENGLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:57 NORTHEASTERN BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-3154
Mailing Address - Country:US
Mailing Address - Phone:603-821-4009
Mailing Address - Fax:603-821-4039
Practice Address - Street 1:57 NORTHEASTERN BLVD STE 202
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-3154
Practice Address - Country:US
Practice Address - Phone:603-821-4009
Practice Address - Fax:603-821-4039
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH084117-23363LF0000X
MANP234699363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner