Provider Demographics
NPI:1740067503
Name:NETTLES, SUMMER NICOLE (FNP-C)
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:NICOLE
Last Name:NETTLES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8818
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31095-8818
Mailing Address - Country:US
Mailing Address - Phone:478-333-6532
Mailing Address - Fax:478-953-6727
Practice Address - Street 1:116 S HOUSTON RD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-3904
Practice Address - Country:US
Practice Address - Phone:478-923-0131
Practice Address - Fax:478-922-6530
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN249898363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily