Healthcare Provider Details

I. General information

NPI: 1245802370
Provider Name (Legal Business Name): NICOLE LYNN PARRISH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2021
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 LEARNING WAY
TALLAHASSEE FL
32306-0001
US

IV. Provider business mailing address

6001 W W KELLEY RD
TALLAHASSEE FL
32311-7721
US

V. Phone/Fax

Practice location:
  • Phone: 850-644-6230
  • Fax:
Mailing address:
  • Phone: 850-264-2555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11013615
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: