Provider Demographics
NPI:1801022017
Name:SPITALNICK, NICOLE B (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:B
Last Name:SPITALNICK
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 HIRAM DR
Mailing Address - Street 2:BUILDING B
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-1844
Mailing Address - Country:US
Mailing Address - Phone:678-945-8300
Mailing Address - Fax:770-445-2060
Practice Address - Street 1:51 HIRAM DR
Practice Address - Street 2:BUILDING B
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-1844
Practice Address - Country:US
Practice Address - Phone:678-945-8300
Practice Address - Fax:770-445-2060
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN197580363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics