Provider Demographics
NPI:1417792920
Name:PIERCE, NICOLE LYNN WILANDER (APRN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNN WILANDER
Last Name:PIERCE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:972 ENGLISH TOWN LN APT 114
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-4673
Mailing Address - Country:US
Mailing Address - Phone:540-848-0537
Mailing Address - Fax:
Practice Address - Street 1:1507 S HIAWASSEE RD STE 206
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5719
Practice Address - Country:US
Practice Address - Phone:407-647-2346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11033687363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner