MEDICARE: BRIANA NICOLE NICHOLSON NP

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	163W00000X	Registered Nurse	224420	TN
2	363LF0000X	Family Nurse Practitioner	40363	TN

General Provider Information

NPI Number	:	1720958390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANA NICOLE NICHOLSON NP

Provider Business Mailing Address
First Line	:	531 BELLINGHAM DR NE
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-2324
Country	:	US
Telephone Number	:	706-455-8241
Fax Number	:

Provider Business Practice Location Address
First Line	:	531 BELLINGHAM DR NE
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-2324
Country	:	US
Telephone Number	:	706-455-8241
Fax Number	:

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

Provider Enumeration Date	:	11/10/2025
Last Update Date	:	02/27/2026

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