Healthcare Provider Details

I. General information

NPI: 1336428911
Provider Name (Legal Business Name): NICOLE NATIONS HOGUE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE NELL NATIONS ARNP

II. Dates (important events)

Enumeration Date: 08/12/2011
Last Update Date: 11/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 DAVIS BLVD STE 402
TAMPA FL
33606-3475
US

IV. Provider business mailing address

PO BOX 917770
ORLANDO FL
32891-0001
US

V. Phone/Fax

Practice location:
  • Phone: 813-259-8689
  • Fax: 813-259-8691
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9263176
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: