Provider Demographics
NPI:1356901821
Name:ANDERSON, NICOLE MARIE (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:MARIE
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1823 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-2713
Mailing Address - Country:US
Mailing Address - Phone:512-795-4142
Mailing Address - Fax:512-623-7536
Practice Address - Street 1:1823 E 7TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-2713
Practice Address - Country:US
Practice Address - Phone:512-795-4142
Practice Address - Fax:512-623-7536
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0994709-NP363L00000X
CA95014738363L00000X
TX1070729363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner