Provider Demographics
NPI:1962401901
Name:TATE, NICOLE (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:TATE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-8428
Mailing Address - Country:US
Mailing Address - Phone:540-368-3700
Mailing Address - Fax:540-369-3787
Practice Address - Street 1:1201 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-8428
Practice Address - Country:US
Practice Address - Phone:540-368-3700
Practice Address - Fax:540-368-3787
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85119207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00851190Medicaid
CAGR0081080Medicaid
CAGR0081080Medicaid
ZZZ14503ZMedicare ID - Type Unspecified
CA00A851190Medicare ID - Type Unspecified
CAGR0081080Medicaid