Nicky S Tomblin, CNM

Primary specialty

Obstetrics & Gynecology Nurse PractitionerTaxonomy code 363LX0001X

License

NMW235760 Issued in CA

Practice address

1315 Jesse Jewell Pkwy NE Ste 200
Gainesville, GA 30501-3822

Phone

(770) 219-9443

NPI assigned

Dec 22, 2015

Last updated

May 8, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Mrs. Nicky S Peterson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Certified Nurse Midwife

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1450742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588896000000",
    "number": "1427413285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1315 JESSE JEWELL PKWY NE STE 200",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013822",
            "telephone_number": "770-219-9443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1315 JESSE JEWELL PKWY NE STE 200",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013822",
            "telephone_number": "770-219-9443"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "743 Spring St NE",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "GA",
            "postal_code": "305013715",
            "country_code": "US",
            "telephone_number": "770-219-9443",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Brewster Blvd",
            "address_2": "Naval Hospital,",
            "address_purpose": "LOCATION",
            "city": "Camp Lejeune",
            "state": "NC",
            "postal_code": "285472538",
            "country_code": "US",
            "telephone_number": "910-449-2573",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TOMBLIN",
        "first_name": "NICKY",
        "middle_name": "S",
        "name_prefix": "Ms.",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-12-22",
        "last_updated": "2020-05-08",
        "certification_date": "2020-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "CA",
            "license": "95003494",
            "primary": false
        },
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "CA",
            "license": "NMW235760",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICKY",
            "last_name": "PETERSON",
            "middle_name": "S",
            "prefix": "MRS.",
            "credential": "CNM",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Amy E Todd, OT
• Cameron Ellise Tolbert, DNP
• Michael E Tolbert, AAC
• Timothy Alan Tolbert, PH.D., ATC
• Aaron Tomberlin, PMHNP-BC
• Krystal Nikia Tomlin, D.C.
• Patrick B Toms, DMD
• John C Tonkin, M.D.
• Hope Toombs, CRNA
• Caroline Torrance, OT

• Obstetrics & Gynecology Nurse Practitioner in Gainesville, GA
• Providers in Gainesville, GA by specialty
• Obstetrics & Gynecology Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.