Provider Demographics
NPI:1598513996
Name:HOLCOMBE, NICOLE JACKSON (CRNA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:JACKSON
Last Name:HOLCOMBE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 SWIFT CREEK CT
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-3710
Mailing Address - Country:US
Mailing Address - Phone:443-867-0516
Mailing Address - Fax:
Practice Address - Street 1:106 SWIFT CREEK CT
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-3710
Practice Address - Country:US
Practice Address - Phone:443-867-0516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11032749367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered