Individual provider Active NPI

Nicole Tryfus

  • Licensed Practical Nurse
  • Johns Creek, GA
National Provider Identifier
1689526402
Registry record updated Feb 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
LPN102782 Issued in GA
Practice address
4265 Johns Creek Pkwy Ste B
Johns Creek, GA 30024-6038
Phone
(770) 462-0910
NPI assigned
Feb 12, 2026
Sex
Unspecified or another gender identity
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 12, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 332562 NY
Licensed Practical Nurse 164W00000X LPN102782 GA Primary

Addresses

Primary practice location

4265 Johns Creek Pkwy Ste B
Johns Creek, GA 30024-6038

Mailing address

5345 Glenn Ivey Dr
Cumming, GA 30028-3359

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

LicenseStateTypeSpecialty
LPN102782GAMDLicensed Practical Nurse

NPI Registry JSON

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

{
    "created_epoch": "1770854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770854400000",
    "number": "1689526402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5345 GLENN IVEY DR",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300283359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4265 JOHNS CREEK PKWY STE B",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300246038",
            "telephone_number": "770-462-0910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRYFUS",
        "first_name": "NICOLE",
        "sole_proprietor": "YES",
        "sex": "X",
        "enumeration_date": "2026-02-12",
        "last_updated": "2026-02-12",
        "certification_date": "2026-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "332562",
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "GA",
            "license": "LPN102782",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johns Creek, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.