1366163008 NPI number — MISS ARIELLE DOMINIQUE NICHOLS CNM

Table of content: MISS ARIELLE DOMINIQUE NICHOLS CNM (NPI 1366163008)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366163008 NPI number — MISS ARIELLE DOMINIQUE NICHOLS CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NICHOLS
Provider First Name:
ARIELLE
Provider Middle Name:
DOMINIQUE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
CNM
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:
1366163008
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4916 SILVER OAK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT PIERCE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34982-7197
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-226-7097
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11100 SUMMER RIDGE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33908-4064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-344-2348
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2022

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: 176B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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