Provider Demographics
NPI:1548629348
Name:JOHNSON, NICOLE LYNNE (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:LYNNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:LYNNE
Other - Last Name:KENT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN, APRN, FNP-C
Mailing Address - Street 1:742 CAPEGLEN RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-7639
Mailing Address - Country:US
Mailing Address - Phone:915-319-3735
Mailing Address - Fax:
Practice Address - Street 1:5465 MARK DABLING BLVD FL 1
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3851
Practice Address - Country:US
Practice Address - Phone:719-358-6428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131949363LF0000X, 363LP2300X
COC-APN.0001542-C-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care