Basic Information
| Provider Information | |||||||||
| NPI: | 1780193276 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MISCHLER | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1250 S 18TH ST STE 202 | ||||||||
| Address2: | |||||||||
| City: | FERNANDINA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320344729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043103888 | ||||||||
| FaxNumber: | 9042778487 | ||||||||
| Practice Location | |||||||||
| Address1: | 1250 S 18TH ST STE 202 | ||||||||
| Address2: | |||||||||
| City: | FERNANDINA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320344729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043103888 | ||||||||
| FaxNumber: | 9042778487 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2017 | ||||||||
| LastUpdateDate: | 04/02/2018 | ||||||||
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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 | 363LF0000X | 9227357 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 207R00000X | ARNP9227357 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.