Provider Demographics
NPI:1962051078
Name:CAMPBELL, NICOLE MARIE (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MARIE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 CHAHO RD
Mailing Address - Street 2:
Mailing Address - City:FARRAGUT
Mailing Address - State:TN
Mailing Address - Zip Code:37934-4643
Mailing Address - Country:US
Mailing Address - Phone:865-406-6118
Mailing Address - Fax:
Practice Address - Street 1:205 CHAHO RD
Practice Address - Street 2:
Practice Address - City:FARRAGUT
Practice Address - State:TN
Practice Address - Zip Code:37934-4643
Practice Address - Country:US
Practice Address - Phone:865-406-6118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26173363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner