MEDICARE: MRS. NICOLE GOLDEN NP-C

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	363LA2200X	Adult Health Nurse Practitioner	AP128880	TX
2	363LP2300X	Primary Care Nurse Practitioner	AP128880	TX
3	363LG0600X	Gerontology Nurse Practitioner	AP128880	TX

General Provider Information

NPI Number	:	1598120701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE GOLDEN NP-C

Provider Business Mailing Address
First Line	:	PO BOX 746079
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6079
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2663 S LANCASTER RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75216-3112
Country	:	US
Telephone Number	:	214-296-4341
Fax Number	:

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

Provider Enumeration Date	:	12/15/2015
Last Update Date	:	08/19/2025

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