Provider Demographics
NPI:1235614439
Name:VINES, NICOLE ELIZABETH (FNP)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ELIZABETH
Last Name:VINES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:ELIZABETH
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2418 W ERIC DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-4250
Mailing Address - Country:US
Mailing Address - Phone:302-528-6769
Mailing Address - Fax:
Practice Address - Street 1:4701 OGLETOWN STANTON RD STE 3400
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-7007
Practice Address - Country:US
Practice Address - Phone:302-366-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0001186363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily