Provider Demographics
NPI:1306440375
Name:MITCHELL-HARVEY, NICOLA BRIDGETTE (FNP-C)
Entity type:Individual
Prefix:
First Name:NICOLA
Middle Name:BRIDGETTE
Last Name:MITCHELL-HARVEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3993 LAWRENCEVILLE HWY NW STE 140
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-2873
Mailing Address - Country:US
Mailing Address - Phone:770-679-9935
Mailing Address - Fax:
Practice Address - Street 1:3993 LAWRENCEVILLE HWY NW STE 140
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2873
Practice Address - Country:US
Practice Address - Phone:770-679-9935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF11200589363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily