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General NPI Number Information
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NPI Number | 1023820388
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Entity Type | Individual
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Provider Name | NICOLLE HORAITIS CRNP
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Gender | Female
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Dates
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Enumeration Date | 01/23/2025
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 1108 ROSS CLARK CIR # 4
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City | DOTHAN
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State | AL
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Zip | 36301-3022
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Country | US
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Telephone | 334-355-1706
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Fax |
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Provider Business Mailing Address
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Address Line | 108 PARK DR
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City | ABBEVILLE
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State | AL
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Zip | 36310-2612
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Country | US
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Telephone | 334-355-1706
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1-152350
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License Number State | AL
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