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NPI Code Detail

MEDICARE: NICOLE RENEE STALLINGS CRNP

MEDICARE: NICOLE RENEE STALLINGS CRNP
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
1363L00000XNurse PractitionerRN305661GA
2363LA2200XAdult Health Nurse PractitionerSP012160PA

General Provider Information

NPI Number : 1538416748
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE RENEE STALLINGS CRNP
Provider Business Mailing Address
First Line : 2450 W HUNTING PARK AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19129-1302
Country : US
Telephone Number : 215-707-4600
Fax Number : 215-707-4034
Provider Business Practice Location Address
First Line : 1800 HOWELL MILL RD NW STE 500
Second Line :
City : ATLANTA
State : GA
Zip : 30318-2594
Country : US
Telephone Number : 404-367-3350
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2012
Last Update Date : 09/19/2024

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