Provider Demographics
NPI:1144830357
Name:EGLE, NICOLE ERIN
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ERIN
Last Name:EGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:ERIN
Other - Last Name:EGLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN-CNP
Mailing Address - Street 1:7574 PARTRIDGE MEADOWS DR E
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-1359
Mailing Address - Country:US
Mailing Address - Phone:216-632-2090
Mailing Address - Fax:
Practice Address - Street 1:23425 COMMERCE PARK STE 104
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5848
Practice Address - Country:US
Practice Address - Phone:216-831-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0027081363LF0000X
OHAPRN.CNP.0027081363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily