Provider Demographics
NPI:1508877267
Name:KROLL, NICOLE LEE (MS RN ANP-C)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LEE
Last Name:KROLL
Suffix:
Gender:F
Credentials:MS RN ANP-C
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:LEE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2403 N LAURENT ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-4119
Mailing Address - Country:US
Mailing Address - Phone:361-579-0315
Mailing Address - Fax:361-579-0325
Practice Address - Street 1:1686 HWY 79 WEST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:TX
Practice Address - Zip Code:75831
Practice Address - Country:US
Practice Address - Phone:903-322-2204
Practice Address - Fax:903-322-7905
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX677656363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health