Provider Demographics
NPI:1780167809
Name:SPALL, NICOLE ANN (APRN-BC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANN
Last Name:SPALL
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 W LINEBAUGH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-7729
Mailing Address - Country:US
Mailing Address - Phone:813-857-4200
Mailing Address - Fax:
Practice Address - Street 1:1202 W LINEBAUGH AVE STE A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-7729
Practice Address - Country:US
Practice Address - Phone:813-857-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9287830363LP0808X
FLARNP9287830363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health