Provider Demographics
NPI:1942951744
Name:CAO-CALLICOTTE, NICOLE PHUONG KHANH (FNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:PHUONG KHANH
Last Name:CAO-CALLICOTTE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:PHUONG KHANH
Other - Last Name:CAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2324 LIMESTONE OVERLOOK
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-7443
Mailing Address - Country:US
Mailing Address - Phone:770-536-8109
Mailing Address - Fax:
Practice Address - Street 1:2324 LIMESTONE OVERLOOK
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-7443
Practice Address - Country:US
Practice Address - Phone:770-536-8109
Practice Address - Fax:678-536-3203
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN279581363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner