Active NPI
Trina Nicksic
- Dental Hygienist
- Fort Collins, CO
National Provider Identifier
1457710220
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 002024275
- Practice address
- 1830 Laporte Ave
Fort Collins, CO 80521-2341 - Phone
- (970) 416-6240
- Fax
- (970) 472-2369
- NPI assigned
- Feb 22, 2016
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 002024275 | CO | Primary |
| Dental Hygienist | 124Q00000X | 10636-16 | WI |
Addresses
Primary practice location
1830 Laporte Ave
Fort Collins, CO 80521-2341
Mailing address
1830 Laporte Ave
Fort Collins, CO 80521-2341
Phone (970) 416-6240
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002024275 | CO | MD | Dental Hygienist |
| 10636-16 | WI | MD | Dental Hygienist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Salud Family Health | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Federally Qualified Health Center (FQHC)
- Fort Morgan, CO
- NPI 1740947407
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1456099200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456099200000",
"number": "1457710220",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1830 LAPORTE AVE",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805212341",
"telephone_number": "970-416-6240",
"fax_number": "970-472-2369"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1830 LAPORTE AVE",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805212341",
"telephone_number": "970-416-6240",
"fax_number": "970-472-2369"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICKSIC",
"first_name": "TRINA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-02-22",
"last_updated": "2016-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "CO",
"license": "002024275",
"primary": true
},
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "WI",
"license": "10636-16",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Collins, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.