Provider Demographics
NPI:1568092047
Name:ANDERSON, NICOLE (MSN, APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MSN, APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14205 HIGHWAY 92 STE 101
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-7138
Mailing Address - Country:US
Mailing Address - Phone:678-293-7854
Mailing Address - Fax:770-591-7573
Practice Address - Street 1:14205 HIGHWAY 92 STE 101
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-7138
Practice Address - Country:US
Practice Address - Phone:678-293-7854
Practice Address - Fax:770-591-7573
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN280911363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily