Provider Demographics
NPI:1043078660
Name:THOMAS, NICOLE D'AMICO
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:D'AMICO
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3309 SHALLOWFORD RD
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-4242
Mailing Address - Country:US
Mailing Address - Phone:205-212-0294
Mailing Address - Fax:
Practice Address - Street 1:3104 BLUE LAKE DR STE 110
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35243-2372
Practice Address - Country:US
Practice Address - Phone:205-977-1949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-160166163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse