Provider Demographics
NPI:1124664883
Name:PARKER, NICOLE RENEE' (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:RENEE'
Last Name:PARKER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:RENEE'
Other - Last Name:TREMBLAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:279 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2120
Practice Address - Country:US
Practice Address - Phone:508-334-8830
Practice Address - Fax:508-334-8835
Is Sole Proprietor?:No
Enumeration Date:2019-11-18
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2294753163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse