Provider Demographics
NPI:1477095552
Name:IRWIN, NICOLE P (MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:P
Last Name:IRWIN
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SUNFLOWER ST
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-1890
Mailing Address - Country:US
Mailing Address - Phone:229-472-3656
Mailing Address - Fax:
Practice Address - Street 1:123 MILL STREET
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:GA
Practice Address - Zip Code:30217-6279
Practice Address - Country:US
Practice Address - Phone:706-948-0068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-07
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN139988363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily