Provider Demographics
NPI:1972816874
Name:BOND, NICOLE PENLAND (APRN, NP-C)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:PENLAND
Last Name:BOND
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:433 HIGHLAND PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:EAST ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540-7658
Mailing Address - Country:US
Mailing Address - Phone:706-253-5514
Mailing Address - Fax:706-635-1411
Practice Address - Street 1:174 HIGHLAND CROSSING EAST
Practice Address - Street 2:
Practice Address - City:EAST ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540
Practice Address - Country:US
Practice Address - Phone:706-635-1400
Practice Address - Fax:706-635-1411
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN175506363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111929Medicare Oscar/Certification