Provider Demographics
NPI:1851344097
Name:HASKINS, NICOLE (RN, CRNP)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:HASKINS
Suffix:
Gender:F
Credentials:RN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 MARLBORO PIKE
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-2841
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6400 MARLBORO PIKE
Practice Address - Street 2:
Practice Address - City:DISTRICT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20747-2841
Practice Address - Country:US
Practice Address - Phone:301-736-7000
Practice Address - Fax:301-736-6916
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR171119363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily