MEDICARE: NICOLE HATCHER PA-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
1	363A00000X	Physician Assistant	0110002968	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0110002968	OTHER	VA	PHYSICIAN ASSISTANT LICENSE

General Provider Information

NPI Number	:	1568481018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE HATCHER PA-C

Provider Business Mailing Address
First Line	:	4000 COLISEUM DR
Second Line	:	STE 445
City	:	HAMPTON
State	:	VA
Zip	:	23666-5906
Country	:	US
Telephone Number	:	757-827-2127
Fax Number	:	757-827-2255

Provider Business Practice Location Address
First Line	:	4000 COLISEUM DR
Second Line	:	STE 445
City	:	HAMPTON
State	:	VA
Zip	:	23666-5906
Country	:	US
Telephone Number	:	757-827-2127
Fax Number	:	757-827-2255

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	05/03/2011

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Directions to “ NICOLE HATCHER PA-C” Practice Location

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