Healthcare Provider Details

I. General information

NPI: 1457187965
Provider Name (Legal Business Name): NICOLE GOINS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5261 CARROLLTON PIKE STE C
WOODLAWN VA
24381-3034
US

IV. Provider business mailing address

5261 CARROLLTON PIKE STE C
WOODLAWN VA
24381-3034
US

V. Phone/Fax

Practice location:
  • Phone: 276-238-0911
  • Fax: 276-238-0912
Mailing address:
  • Phone: 276-238-0911
  • Fax: 276-238-0912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024190927
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: