Provider Demographics
NPI:1477074516
Name:TATE, NICOLE NALLEY (FNP-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:NALLEY
Last Name:TATE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 S HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:NC
Mailing Address - Zip Code:28164-2055
Mailing Address - Country:US
Mailing Address - Phone:704-263-1416
Mailing Address - Fax:
Practice Address - Street 1:442 S HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:NC
Practice Address - Zip Code:28164-2055
Practice Address - Country:US
Practice Address - Phone:704-263-1416
Practice Address - Fax:401-652-9787
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC216403363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily