Provider Demographics
NPI:1568481018
Name:HATCHER, NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:HATCHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 COLISEUM DR
Mailing Address - Street 2:STE 445
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-5906
Mailing Address - Country:US
Mailing Address - Phone:757-827-2127
Mailing Address - Fax:757-827-2255
Practice Address - Street 1:4000 COLISEUM DR
Practice Address - Street 2:STE 445
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5906
Practice Address - Country:US
Practice Address - Phone:757-827-2127
Practice Address - Fax:757-827-2255
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002968363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0110002968OtherPHYSICIAN ASSISTANT LICENSE