Basic Information
| Provider Information | |||||||||
| NPI: | 1568481018 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HATCHER | ||||||||
| FirstName: | NICOLE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4000 COLISEUM DR | ||||||||
| Address2: | STE 445 | ||||||||
| City: | HAMPTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236665906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578272127 | ||||||||
| FaxNumber: | 7578272255 | ||||||||
| Practice Location | |||||||||
| Address1: | 4000 COLISEUM DR | ||||||||
| Address2: | STE 445 | ||||||||
| City: | HAMPTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236665906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578272127 | ||||||||
| FaxNumber: | 7578272255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 05/03/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 0110002968 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 0110002968 | 01 | VA | PHYSICIAN ASSISTANT LICENSE | OTHER |