Provider Demographics
NPI:1457873267
Name:COOK, NICHOLAS ANDREW (NCPT, SFIDC)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:ANDREW
Last Name:COOK
Suffix:
Gender:M
Credentials:NCPT, SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIT 100298 BOX 1
Mailing Address - Street 2:(PC11) USS WHIRLWIND
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09591
Mailing Address - Country:US
Mailing Address - Phone:808-429-5884
Mailing Address - Fax:
Practice Address - Street 1:UNIT 100298 BOX 1
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09591-9800
Practice Address - Country:US
Practice Address - Phone:808-429-5884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman