Basic Information
| Provider Information | |||||||||
| NPI: | 1497801070 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALMER | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | NABORS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1010 AIRPARK CENTER DR | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372175200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152214400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2898 MAHAN DR STE 5 | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323085462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152214400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2007 | ||||||||
| LastUpdateDate: | 09/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 28189 | AL | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 390200000X | TL-833 | CO | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207ZP0102X | ME107560 | FL | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 009910546 | 05 | AL | MEDICAID | P00810644 | 01 | AL | RAILROAD, TRAVELERS | OTHER | 009910548 | 05 | AL | MEDICAID | 051542020 | 01 | AL | BCBS | OTHER | 009910547 | 05 | AL | MEDICAID | 051542018 | 01 | AL | BCBS | OTHER | 051542019 | 01 | AL | BCBS | OTHER |