Individual provider Active NPI

Nicole M. Papanicolas, NP

  • Nurse Practitioner
  • Falls Church, VA
National Provider Identifier
1780179192
Registry record updated May 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
0024176274 Issued in VA
Practice address
3300 Gallows Rd
Falls Church, VA 22042-3300
Phone
(703) 776-4001
Fax
(703) 776-7113
NPI assigned
Jun 27, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 26, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 0024176274 VA Primary

Addresses

Primary practice location

3300 Gallows Rd
Falls Church, VA 22042-3300

Mailing address

3300 Gallows Rd
Falls Church, VA 22042-3300
Phone (703) 776-4001

Other practice location 1

8503 Arlington Blvd
Fairfax, VA 22031-4628
Phone (701) 970-3125

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, CT2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20181119000860 DC Practitioner - Nurse Practitioner 4082968680 Reassigns benefits to 1 organization
I20251002000575 CT Practitioner - Nurse Practitioner 4082968680 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

424 Church St
Nashville, TN 37219-2301

7113 Swift Run Trails Dr
Fairfax Station, VA 22039-2122

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Matrix Medical Plus Nurse Practitioner CurrentSince Sep 1, 2025 Accepting new patients
Lifetime Internal Medicine, PLLC Current Accepting new patients

Locations

9201 E Mountain View Rd
Ste 220
Scottsdale, AZ 85258
Phone (480) 862-1883

1224 Mill St
Bldg B
East Berlin, CT 06023
Phone (860) 406-4894

2579 John Milton Dr
Ste 300
Herndon, VA 20171
Phone (703) 391-0211

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/18535/brand/1/csg/1/fhir/r4

Organizations & group practices 3

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": "1530057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621987200000",
    "number": "1780179192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 GALLOWS RD",
            "city": "FALLS CHURCH",
            "state": "VA",
            "postal_code": "220423300",
            "telephone_number": "703-776-4001",
            "fax_number": "703-776-7113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 GALLOWS RD",
            "city": "FALLS CHURCH",
            "state": "VA",
            "postal_code": "220423300",
            "telephone_number": "703-776-4001",
            "fax_number": "703-776-7113"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8503 Arlington Blvd",
            "address_purpose": "LOCATION",
            "city": "Fairfax",
            "state": "VA",
            "postal_code": "220314628",
            "country_code": "US",
            "telephone_number": "701-970-3125",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PAPANICOLAS",
        "first_name": "NICOLE",
        "middle_name": "M.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-27",
        "last_updated": "2021-05-26",
        "certification_date": "2021-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "VA",
            "license": "0024176274",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Falls Church, VA

Sources for this page

Verify at the official NPI Registry.