MEDICARE: DR. NICOLE LEA FREDERICK DNP, APRN,ACCNS-AG

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	364SC0200X	Critical Care Medicine Clinical Nurse Specialist	31465	TX

General Provider Information

NPI Number	:	1033768866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE LEA FREDERICK DNP, APRN,ACCNS-AG

Provider Business Mailing Address
First Line	:	2001 THISTLE PARK DR APT 5105
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-1651
Country	:	US
Telephone Number	:	817-907-6953
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 THISTLE PARK DR APT 5105
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-1651
Country	:	US
Telephone Number	:	817-907-6953
Fax Number	:

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

Provider Enumeration Date	:	09/04/2019
Last Update Date	:	09/04/2019

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