MEDICARE: NICOLE POOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	71006454A	IN

General Provider Information

NPI Number	:	1033561139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE POOR

Provider Business Mailing Address
First Line	:	11109 PARKVIEW PLAZA DR # 117
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11104 PARKVIEW CIRCLE DR STE 20
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1733
Country	:	US
Telephone Number	:	260-425-6050
Fax Number	:	260-425-6059

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2016
Last Update Date	:	02/02/2026

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Directions to “ NICOLE POOR ” Practice Location

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