Provider Demographics
NPI:1487234662
Name:KODA, NICOLE LYN (APRN)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:LYN
Last Name:KODA
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 1:13425 BELCHER RD S
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-4009
Mailing Address - Country:US
Mailing Address - Phone:727-221-9924
Mailing Address - Fax:727-303-3193
Practice Address - Street 1:13425 BELCHER RD S
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-4009
Practice Address - Country:US
Practice Address - Phone:727-221-9924
Practice Address - Fax:727-303-3193
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11008160363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily