Healthcare Provider Details

I. General information

NPI: 1346075652
Provider Name (Legal Business Name): NICOLE MICHELLE HAMES DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE MICHELLE CARLO

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ELM ST N
FARGO ND
58102-2417
US

IV. Provider business mailing address

2101 ELM ST N
FARGO ND
58102-2417
US

V. Phone/Fax

Practice location:
  • Phone: 701-239-3700
  • Fax:
Mailing address:
  • Phone: 727-248-0102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number9579185
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201399
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: