Provider Demographics
NPI:1841256740
Name:HOUSER, NICOLE COURTNEY (PA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:COURTNEY
Last Name:HOUSER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13020 LIVINGSTON RD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-5021
Mailing Address - Country:US
Mailing Address - Phone:412-418-4719
Mailing Address - Fax:
Practice Address - Street 1:13020 LIVINGSTON RD
Practice Address - Street 2:SUITE 14
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34105-5021
Practice Address - Country:US
Practice Address - Phone:239-263-3330
Practice Address - Fax:239-263-7492
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109381363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ08363Medicare UPIN