Provider Demographics
NPI:1679635106
Name:TOMLINSON VANNESS, NICOLE (LICENSED ATC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:TOMLINSON VANNESS
Suffix:
Gender:F
Credentials:LICENSED ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 E PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-8000
Mailing Address - Country:US
Mailing Address - Phone:704-663-3777
Mailing Address - Fax:704-664-6615
Practice Address - Street 1:128 E PLAZA DR
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-8000
Practice Address - Country:US
Practice Address - Phone:704-663-3777
Practice Address - Fax:704-664-6615
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC05782255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC974768OtherMEMBER
NC0578OtherNC LICENSE