Provider Demographics
NPI:1235375007
Name:SPAIN, NICQUIA (DO)
Entity Type:Individual
Prefix:
First Name:NICQUIA
Middle Name:
Last Name:SPAIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4535 SPOTSYLVANIA PKWY
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-7768
Mailing Address - Country:US
Mailing Address - Phone:540-604-5186
Mailing Address - Fax:540-604-5187
Practice Address - Street 1:4535 SPOTSYLVANIA PKWY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-7768
Practice Address - Country:US
Practice Address - Phone:540-604-5186
Practice Address - Fax:540-604-5187
Is Sole Proprietor?:No
Enumeration Date:2008-12-30
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT012545207Q00000X
VA0102202803207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine