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General NPI Number Information
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NPI Number | 1447914114
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Entity Type | Individual
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Provider Name | NICOLE LOUISE LUCKSHIS APRN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/28/2021
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Last Update Date | 10/28/2021
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Provider Practice Location Address
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Address Line | 1310 24TH AVE S
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City | NASHVILLE
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State | TN
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Zip | 37212-2637
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Country | US
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Telephone | 615-873-6849
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Fax |
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Provider Business Mailing Address
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Address Line | 2385 MARTIN COVINGTON RD
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City | WHITE HOUSE
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State | TN
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Zip | 37188-1200
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Country | US
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Telephone | 615-513-6191
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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 | 30195
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License Number State | TN
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