1316172083 NPI number — NICOLE TIQUANA CALDWELL C.N.A./P.C.T./M.H.T.

Table of content: NICOLE TIQUANA CALDWELL C.N.A./P.C.T./M.H.T. (NPI 1316172083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316172083 NPI number — NICOLE TIQUANA CALDWELL C.N.A./P.C.T./M.H.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CALDWELL
Provider First Name:
NICOLE
Provider Middle Name:
TIQUANA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
C.N.A./P.C.T./M.H.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAWKINS
Provider Other First Name:
NICOLE
Provider Other Middle Name:
TIQUANA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1316172083
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 100736
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33310-0736
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-708-4646
Provider Business Mailing Address Fax Number:
754-206-2147

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 NW 5TH AVE # 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33311-6027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-708-4646
Provider Business Practice Location Address Fax Number:
754-206-2147
Provider Enumeration Date:
05/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 376K00000X , with the licence number:  C.N.A 127560 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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