Provider Demographics
NPI:1013177948
Name:SWOFFORD, NICOLE SUSANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:SUSANNE
Last Name:SWOFFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6257 FM 2642 BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROYSE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75189-3224
Mailing Address - Country:US
Mailing Address - Phone:469-800-3670
Mailing Address - Fax:469-800-3680
Practice Address - Street 1:6257 FM 2642 BLVD
Practice Address - Street 2:
Practice Address - City:ROYSE CITY
Practice Address - State:TX
Practice Address - Zip Code:75189-3223
Practice Address - Country:US
Practice Address - Phone:469-800-3670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7354207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2818775-01Medicaid
TX2818775-01Medicaid
TXP01029030Medicare PIN