Provider Demographics
NPI:1477910941
Name:CAMP, NICOLE JANE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:JANE
Last Name:CAMP
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:601 PROFESSIONAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046
Mailing Address - Country:US
Mailing Address - Phone:678-393-6348
Mailing Address - Fax:678-541-6763
Practice Address - Street 1:601 PROFESSIONAL DRIVE
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046
Practice Address - Country:US
Practice Address - Phone:678-393-6348
Practice Address - Fax:678-541-6763
Is Sole Proprietor?:No
Enumeration Date:2016-01-28
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN217901176B00000X, 163W00000X
GARN 217901363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No176B00000XOther Service ProvidersMidwife
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN 217901OtherNURSING LICENSE