Provider Demographics
NPI:1558981803
Name:GOODE, NICOLE NADINE (FNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:NADINE
Last Name:GOODE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:NADINE
Other - Last Name:CRYSTAL/SMITH/GUERRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3609 HOLLANDS BRANCH CT
Mailing Address - Street 2:
Mailing Address - City:STREET
Mailing Address - State:MD
Mailing Address - Zip Code:21154-2014
Mailing Address - Country:US
Mailing Address - Phone:443-900-0810
Mailing Address - Fax:
Practice Address - Street 1:3609 HOLLANDS BRANCH CT
Practice Address - Street 2:
Practice Address - City:STREET
Practice Address - State:MD
Practice Address - Zip Code:21154-2014
Practice Address - Country:US
Practice Address - Phone:443-900-0810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9390067363LF0000X
VA0024180638363LF0000X
MDR206455363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily