MEDICARE: NICOLLE MARIA DIGEROLAMO-THALLER APRN, BC

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	363LF0000X	Family Nurse Practitioner	RN149962	GA

General Provider Information

NPI Number	:	1881873099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLLE MARIA DIGEROLAMO-THALLER APRN, BC

Provider Business Mailing Address
First Line	:	1497 FAIR RD STE 102
Second Line	:
City	:	STATESBORO
State	:	GA
Zip	:	30458-0823
Country	:	US
Telephone Number	:	912-764-9001
Fax Number	:	912-764-3166

Provider Business Practice Location Address
First Line	:	1497 FAIR RD STE 102
Second Line	:
City	:	STATESBORO
State	:	GA
Zip	:	30458-0823
Country	:	US
Telephone Number	:	912-764-9001
Fax Number	:	912-764-3166

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

Provider Enumeration Date	:	10/24/2007
Last Update Date	:	03/15/2024

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