Provider Demographics
NPI:1497801070
Name:BALMER, NICOLE NABORS (MD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:NABORS
Last Name:BALMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 AIRPARK CENTER DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-5200
Mailing Address - Country:US
Mailing Address - Phone:615-221-4400
Mailing Address - Fax:
Practice Address - Street 1:2898 MAHAN DR STE 5
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5462
Practice Address - Country:US
Practice Address - Phone:615-221-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL28189207ZP0102X
COTL-833390200000X
FLME107560207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009910546Medicaid
ALP00810644OtherRAILROAD, TRAVELERS
AL009910548Medicaid
AL051542020OtherBCBS
AL009910547Medicaid
AL051542018OtherBCBS
AL051542019OtherBCBS
AL009910546Medicaid