MEDICARE: NICOLE THOMAS ROBERSON NP-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	363LF0000X	Family Nurse Practitioner	RN235687	GA

General Provider Information

NPI Number	:	1932693603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE THOMAS ROBERSON NP-C

Provider Business Mailing Address
First Line	:	510 SPARTA RD
Second Line	:
City	:	SANDERSVILLE
State	:	GA
Zip	:	31082-1859
Country	:	US
Telephone Number	:	478-707-1770
Fax Number	:	906-257-6591

Provider Business Practice Location Address
First Line	:	510 SPARTA RD
Second Line	:
City	:	SANDERSVILLE
State	:	GA
Zip	:	31082-1859
Country	:	US
Telephone Number	:	478-707-1770
Fax Number	:	906-257-6591

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

Provider Enumeration Date	:	06/18/2018
Last Update Date	:	08/20/2024

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