Provider Demographics
NPI:1831585843
Name:SPEEGLE, NICOLE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:SPEEGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 WATERMELON RD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-5246
Mailing Address - Country:US
Mailing Address - Phone:205-752-7445
Mailing Address - Fax:205-556-8868
Practice Address - Street 1:NORTH SHELBY FAMILY HEALTH, PC
Practice Address - Street 2:2520 VALLEYDALE ROAD
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-2019
Practice Address - Country:US
Practice Address - Phone:205-980-9944
Practice Address - Fax:205-980-9844
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-07
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALF0115088363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily