Provider Demographics
NPI:1356644488
Name:SPECKHARD, NICOLE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:SPECKHARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:VERCONTAIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:40 GEORGETOWN DR
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-4214
Mailing Address - Country:US
Mailing Address - Phone:972-658-3554
Mailing Address - Fax:
Practice Address - Street 1:73 FRONT ST
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:MA
Practice Address - Zip Code:01464-2575
Practice Address - Country:US
Practice Address - Phone:978-906-0060
Practice Address - Fax:978-906-0012
Is Sole Proprietor?:No
Enumeration Date:2010-12-12
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA4067363AM0700X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical