Provider Demographics
NPI:1851312532
Name:SCOTT, NADINE L (PA-C)
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:L
Last Name:SCOTT
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 1:10460 PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-8536
Mailing Address - Country:US
Mailing Address - Phone:704-541-3055
Mailing Address - Fax:704-289-4515
Practice Address - Street 1:10460 PARK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8536
Practice Address - Country:US
Practice Address - Phone:704-541-3055
Practice Address - Fax:704-289-4515
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000041363A00000X
NC03555363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTS52024Medicare UPIN
CT970002152Medicare ID - Type Unspecified