Individual provider Active NPI

Nicole Catherine Polillio, NP

  • Family Nurse Practitioner
  • Providence, RI
National Provider Identifier
1033004189
Registry record updated Sep 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN04767 Issued in RI
Practice address
101 Dudley St
Providence, RI 02905-2401
Phone
(401) 274-1100
NPI assigned
Jun 10, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APRN04767 RI Primary
Family Nurse Practitioner 363LF0000X F05250649 MA

Addresses

Primary practice location

101 Dudley St
Providence, RI 02905-2401

Mailing address

455 Toll Gate Rd
PRC and Credentialing
Warwick, RI 02886-2759
Phone (401) 273-0641

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250915003530 RI Practitioner - Nurse Practitioner 6800399783 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Massachusetts Medical School, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

455 Toll Gate Rd
Warwick, RI 02886-2770

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F05250649MAMDFamily Nurse Practitioner
APRN04767RIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Affinity Physicians LLC. Current Accepting new patients
Affinity Physicians LLC CurrentSince Nov 2, 2025 Accepting new patients

Locations

101 Dudley St
Providence, RI 02905
Phone (401) 453-7950

455 Toll Gate Rd
Warwick, RI 02886
Phone (401) 737-7000

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1749513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756857600000",
    "number": "1033004189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 TOLL GATE RD",
            "address_2": "PRC AND CREDENTIALING",
            "city": "WARWICK",
            "state": "RI",
            "postal_code": "028862759",
            "telephone_number": "401-273-0641",
            "fax_number": "401-273-2919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 DUDLEY ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029052401",
            "telephone_number": "401-274-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLILLIO",
        "first_name": "NICOLE",
        "middle_name": "CATHERINE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-06-10",
        "last_updated": "2025-09-03",
        "certification_date": "2025-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "RI",
            "license": "APRN04767",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MA",
            "license": "F05250649",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.