Provider Demographics
NPI:1699781336
Name:HOPKINS, NICOLE M (PA-C)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:HOPKINS
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:M
Other - Last Name:PAUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2112 E 38TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-1135
Mailing Address - Country:US
Mailing Address - Phone:563-359-0324
Mailing Address - Fax:563-359-9409
Practice Address - Street 1:2112 E 38TH ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-1135
Practice Address - Country:US
Practice Address - Phone:563-359-0324
Practice Address - Fax:563-359-9409
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2025-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01193363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAS84938Medicare UPIN