=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558981803
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLE NADINE GOODE FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2020
-----------------------------------------------------
Last Update Date | 04/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3609 HOLLANDS BRANCH CT
-----------------------------------------------------
City | STREET
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21154-2014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-900-0810
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3609 HOLLANDS BRANCH CT
-----------------------------------------------------
City | STREET
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21154-2014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-900-0810
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN9390067
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 0024180638
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | R206455
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------