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NPI Code Detail

MEDICARE: NICOLE ELIZABETH EIDSON FNP-C

MEDICARE: NICOLE ELIZABETH EIDSON FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerAP116912TX
2363LF0000XFamily Nurse PractitionerAP3167AZ

General Provider Information

NPI Number : 1558514745
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE ELIZABETH EIDSON FNP-C
Provider Business Mailing Address
First Line : 1855 GATTIS SCHOOL RD
Second Line :
City : ROUND ROCK
State : TX
Zip : 78664-7428
Country : US
Telephone Number : 866-389-2727
Fax Number : 401-216-2854
Provider Business Practice Location Address
First Line : 1855 GATTIS SCHOOL RD
Second Line :
City : ROUND ROCK
State : TX
Zip : 78664-7428
Country : US
Telephone Number : 866-389-2727
Fax Number : 401-216-2854
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2008
Last Update Date : 02/03/2026

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