Provider Demographics
NPI:1760049787
Name:HALLFORD, NICOLE D (CRNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:D
Last Name:HALLFORD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:D
Other - Last Name:MAGGARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1118 ROSS CLARK CIR STE 704
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-3030
Mailing Address - Country:US
Mailing Address - Phone:334-699-6396
Mailing Address - Fax:
Practice Address - Street 1:1118 ROSS CLARK CIR STE 704
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3030
Practice Address - Country:US
Practice Address - Phone:334-699-6396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-172759363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner