Provider Demographics
NPI:1992241145
Name:EVANS, NICHOLE MARIE (FNP)
Entity type:Individual
Prefix:MISS
First Name:NICHOLE
Middle Name:MARIE
Last Name:EVANS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4830 INNISBROOK CT
Mailing Address - Street 2:#1
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-6609
Mailing Address - Country:US
Mailing Address - Phone:843-246-1326
Mailing Address - Fax:
Practice Address - Street 1:10317 OCEAN HIGHWAY 17 SOUTH
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585
Practice Address - Country:US
Practice Address - Phone:843-237-4036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20695363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily