Provider Demographics
NPI:1780981159
Name:BODINE, NICOLE M (CRNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:BODINE
Suffix:
Gender:F
Credentials:CRNP
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 2699
Mailing Address - Street 2:ATTN SHMG/HPE
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:251-967-4000
Mailing Address - Fax:251-967-2398
Practice Address - Street 1:1700 W 2ND ST
Practice Address - Street 2:
Practice Address - City:GULF SHORES
Practice Address - State:AL
Practice Address - Zip Code:36542-3422
Practice Address - Country:US
Practice Address - Phone:251-967-4000
Practice Address - Fax:251-967-2398
Is Sole Proprietor?:No
Enumeration Date:2011-02-22
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-104085363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily