Provider Demographics
NPI:1922537562
Name:TOD, NICOLE MARIE (DO)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:TOD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10840 TEXAS HEALTH TRL STE 265
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-6852
Mailing Address - Country:US
Mailing Address - Phone:817-741-2601
Mailing Address - Fax:
Practice Address - Street 1:10840 TEXAS HEALTH TRL STE 265
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-6852
Practice Address - Country:US
Practice Address - Phone:817-741-2601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXS2521207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program