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NPI Code Detail

MEDICARE: MRS. NICOLE TUCKER GATHWRIGHT M.S., C.C.C.-S.L.P.

MEDICARE: MRS. NICOLE TUCKER GATHWRIGHT M.S., C.C.C.-S.L.P.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language PathologistSA 5826FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1SA 5826OTHERFLSTATE LICENSURE
213425301OTHERFLIND CITRUS ID#
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4Y905LOTHERFLBCBS FL
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1235240201
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NICOLE TUCKER GATHWRIGHT M.S., C.C.C.-S.L.P.
Provider Business Mailing Address
First Line : 1215 E ORANGE ST
Second Line :
City : LAKELAND
State : FL
Zip : 33801-5762
Country : US
Telephone Number : 863-802-3800
Fax Number : 863-802-0480
Provider Business Practice Location Address
First Line : 1215 E ORANGE ST
Second Line :
City : LAKELAND
State : FL
Zip : 33801-5762
Country : US
Telephone Number : 863-802-3800
Fax Number : 863-802-0480
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 02/14/2011

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