Provider Demographics
NPI:1881873099
Name:DIGEROLAMO-THALLER, NICOLLE MARIA (APRN, BC)
Entity type:Individual
Prefix:
First Name:NICOLLE
Middle Name:MARIA
Last Name:DIGEROLAMO-THALLER
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 1:1497 FAIR RD STE 102
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-0823
Mailing Address - Country:US
Mailing Address - Phone:912-764-9001
Mailing Address - Fax:912-764-3166
Practice Address - Street 1:1497 FAIR RD STE 102
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-0823
Practice Address - Country:US
Practice Address - Phone:912-764-9001
Practice Address - Fax:912-764-3166
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN149962363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily