Individual ProviderNicole JativaNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address4401 Penn Ave, 3rd Floor, Pittsburgh, PA 15224-1334(412) 692-6110PECOS EnrollmentBased on the most recent information from CMS, provider Nicole Jativa does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 10:04 AM.Profile DetailsProvider ID1013294917Provider TypeIndividualFull NameJativa, NicoleGenderFemaleSole ProprietorNoEnumeration Date11/7/2011Last Updated3/25/2021Contact InformationPractice LocationPractice Address4401 Penn Ave, 3rd Floor, Pittsburgh, PA 15224-1334Phone(412) 692-6110FaxUnlisted FaxMailing LocationMailing Address4401 Penn Ave, 3rd Floor, Pittsburgh, PA 15224-1334PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseSP011367Pennsylvania