Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Nicole Petersen

Individual provider Family Nurse Practitioner · NPI 1710840012

Nicole Petersen is a Nurse Practitioner in Draper, Utah. Qualified in 2024, 2 years ago. Licensed in Utah.

Years since qualifying
2
Licensed in
UT
In the registry since
2025
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Practice location Address checks out

14942 S Vintage View Ct
Draper, UT 84020-3303
Phone: (307) 679-4886
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 11102214-4405 (UT)

Record details

NPI number1710840012
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedDecember 4, 2025
Last updated in NPPESDecember 4, 2025
Certification dateDecember 4, 2025
Mailing address14942 S Vintage View Ct, Draper, UT 84020-3303

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

Other providers in Draper