Active NPI
Nina Christie Nicolas, NP
- Nurse Practitioner
- Orange, CA
National Provider Identifier
1073846754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- RN713659
- Practice address
- 700 S Tustin St
Orange, CA 92866-3425 - Phone
- (714) 922-4177
- NPI assigned
- Sep 11, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | RN713659 | CA | Primary |
Addresses
Primary practice location
700 S Tustin St
Orange, CA 92866-3425
Mailing address
146 Blaze
Irvine, CA 92618
Phone (949) 981-1602
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 713659 | Medicaid | CA | |
| NP19255 | Medicaid | CA |
Other names 1
- Nina Carunungan
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19255 | CA | MD | Physical Therapist |
| RN713659 | CA | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1252627200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1325808000000",
"number": "1073846754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "146 BLAZE",
"city": "IRVINE",
"state": "CA",
"postal_code": "92618",
"telephone_number": "949-981-1602"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 S TUSTIN ST",
"city": "ORANGE",
"state": "CA",
"postal_code": "928663425",
"telephone_number": "714-922-4177"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICOLAS",
"first_name": "NINA",
"middle_name": "CHRISTIE",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-09-11",
"last_updated": "2012-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "CA",
"license": "RN713659",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "713659",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "NP19255",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "NINA",
"last_name": "CARUNUNGAN",
"credential": "NP",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Orange, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.