Provider Demographics
NPI:1992112007
Name:SULLIVAN, NICKCOLA LEE (AGNP)
Entity type:Individual
Prefix:MS
First Name:NICKCOLA
Middle Name:LEE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:MRS
Other - First Name:NICKCOLA
Other - Middle Name:SULLIVAN
Other - Last Name:HUFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGNP
Mailing Address - Street 1:75 MONTE VISTA TER
Mailing Address - Street 2:
Mailing Address - City:CANDLER
Mailing Address - State:NC
Mailing Address - Zip Code:28715-9436
Mailing Address - Country:US
Mailing Address - Phone:828-381-2788
Mailing Address - Fax:
Practice Address - Street 1:75 MONTE VISTA TER
Practice Address - Street 2:
Practice Address - City:CANDLER
Practice Address - State:NC
Practice Address - Zip Code:28715-9436
Practice Address - Country:US
Practice Address - Phone:828-381-2788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC145454363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health