Provider Demographics
NPI:1861297707
Name:KRUZICH, NICOLETTE ANGELA (PA-C)
Entity type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:ANGELA
Last Name:KRUZICH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21041 OAK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:IN
Mailing Address - Zip Code:46069-9720
Mailing Address - Country:US
Mailing Address - Phone:847-363-8677
Mailing Address - Fax:
Practice Address - Street 1:8111 S EMERSON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8601
Practice Address - Country:US
Practice Address - Phone:317-528-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant