Provider Demographics
NPI:1295331346
Name:NICHOLS, MARSHA COOK (APRN)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:COOK
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4844 KELLY MILL RD
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:FL
Mailing Address - Zip Code:32564-8944
Mailing Address - Country:US
Mailing Address - Phone:850-537-2583
Mailing Address - Fax:
Practice Address - Street 1:5914 JEFF ATES RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32583-8233
Practice Address - Country:US
Practice Address - Phone:850-981-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1432772363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care