Provider Demographics
NPI:1992253751
Name:PAGE, NICOLE ELLIS (NP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ELLIS
Last Name:PAGE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:LYNN
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:441 DONELSON PIKE
Mailing Address - Street 2:SUITE 395
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3568
Mailing Address - Country:US
Mailing Address - Phone:615-367-1444
Mailing Address - Fax:615-367-1445
Practice Address - Street 1:441 DONELSON PIKE
Practice Address - Street 2:SUITE 395
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-3568
Practice Address - Country:US
Practice Address - Phone:615-367-1444
Practice Address - Fax:615-367-1445
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN181828163W00000X
TN21633363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse