Provider Demographics
NPI:1568907400
Name:MARKS, NICOLE SHORT
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:SHORT
Last Name:MARKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 ENON SPRINGS RD E
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-4409
Mailing Address - Country:US
Mailing Address - Phone:615-355-0805
Mailing Address - Fax:615-355-1807
Practice Address - Street 1:570 ENON SPRINGS RD E
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-4409
Practice Address - Country:US
Practice Address - Phone:615-355-0805
Practice Address - Fax:615-355-1807
Is Sole Proprietor?:No
Enumeration Date:2017-01-02
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27264183500000X
NC17005183500000X
SC10339183500000X
VA202211271183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist