Provider Demographics
NPI:1376107839
Name:BOCK, NICOLE MARIE (DNP, APN, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MARIE
Last Name:BOCK
Suffix:
Gender:F
Credentials:DNP, APN, FNP-C
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:MARIE
Other - Last Name:KORDZIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, APN, FNP-C
Mailing Address - Street 1:975 NJ-73 NORTH
Mailing Address - Street 2:SUITE E
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053
Mailing Address - Country:US
Mailing Address - Phone:609-910-0270
Mailing Address - Fax:
Practice Address - Street 1:975 NJ-73 NORTH
Practice Address - Street 2:SUITE E
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053
Practice Address - Country:US
Practice Address - Phone:609-910-0270
Practice Address - Fax:609-380-2935
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR18161900163W00000X
NJ26NJ00927200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse