Fatigue of superelastic Nitinol in the mixed austenite–martensite state was examined in tension using center-tapered dog-bone specimens. A prestraining procedure, mimicking the load history of a medical device component, was applied prior to cycling: specimens were loaded to a fully martensitic state, unloaded partway into the lower plateau to a mixed-phase state, and then subjected to sinusoidal displacement cycles. Strain maps, obtained using digital image correlation, showed substantial variation in local mean and alternating strains across the gage section. In situ surface imaging using a high-speed camera confirmed crack initiation in a narrow transition zone between austenite and martensite that undergoes cyclic stress-induced martensitic transformation (SIMT). Fatigue life data showed an abrupt transition from high-cycle runouts to low-cycle fatigue failures at a stress amplitude level corresponding to the threshold for activating cyclic SIMT. The fatigue threshold can be estimated from the tensile loading–unloading curve.