Provider Demographics
NPI:1326816281
Name:EMBLETON-ACHORN, NICOLE MARIE (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:EMBLETON-ACHORN
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:MARIE
Other - Last Name:ACHORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGACNP-BC
Mailing Address - Street 1:4 GLEN COVE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-4235
Mailing Address - Country:US
Mailing Address - Phone:207-301-3090
Mailing Address - Fax:207-301-5295
Practice Address - Street 1:4 GLEN COVE DR STE 101
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-4235
Practice Address - Country:US
Practice Address - Phone:207-301-3090
Practice Address - Fax:207-301-5295
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP231380363L00000X, 363LG0600X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology