1861610784 NPI number — NICHOLE AMBER BOYER M. A., CCC-SLP

Table of content: NICHOLE AMBER BOYER M. A., CCC-SLP (NPI 1861610784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861610784 NPI number — NICHOLE AMBER BOYER M. A., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOYER
Provider First Name:
NICHOLE
Provider Middle Name:
AMBER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M. A., CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861610784
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1510 SE 14TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCALA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34471-4531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-351-5560
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2760 SE 17TH ST
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34471-5571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-817-6958
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/23/2007

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: 235Z00000X , with the licence number:  SA5967 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: S2281 . This is a "BC-BS PROV. #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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