Provider Demographics
NPI:1427660349
Name:MARSHALL, NICOLE THERESA (APRN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:THERESA
Last Name:MARSHALL
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 1:800 CLEMATIS ST STE 5-531
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-5107
Mailing Address - Country:US
Mailing Address - Phone:561-671-4036
Mailing Address - Fax:
Practice Address - Street 1:1250 SOUTHWINDS DR
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-1459
Practice Address - Country:US
Practice Address - Phone:561-547-6800
Practice Address - Fax:561-547-6865
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-21
Last Update Date:2021-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11008737363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily