Provider Demographics
NPI:1558175562
Name:DAVIS, NICOLE (FNP-C, ENP-C)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:FNP-C, ENP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3098 W EXECUTIVE PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84048-4911
Mailing Address - Country:US
Mailing Address - Phone:801-349-2480
Mailing Address - Fax:
Practice Address - Street 1:3098 W EXECUTIVE PKWY STE 300
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84048-4911
Practice Address - Country:US
Practice Address - Phone:801-349-2480
Practice Address - Fax:385-900-1671
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7921527-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner