Provider Demographics
NPI:1780167809
Name:SPALL, NICOLE ANN (APRN-BC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANN
Last Name:SPALL
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 BALTIMORE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2472
Mailing Address - Country:US
Mailing Address - Phone:301-722-0148
Mailing Address - Fax:833-903-0130
Practice Address - Street 1:1507 S TUTTLE AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2608
Practice Address - Country:US
Practice Address - Phone:301-722-0484
Practice Address - Fax:833-903-0130
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9287830363LF0000X
FLAPRN9287830363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health