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NPI Code Detail

MEDICARE: NICOLE FONG

MEDICARE: NICOLE FONG
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
1104100000XSocial WorkerFL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518472943
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE FONG
Provider Business Mailing Address
First Line : 520 N SEMORAN BLVD STE 280
Second Line :
City : ORLANDO
State : FL
Zip : 32807-3337
Country : US
Telephone Number : 407-306-9766
Fax Number :
Provider Business Practice Location Address
First Line : 1655 PALM BEACH LAKES BLVD STE 600
Second Line :
City : WEST PALM BEACH
State : FL
Zip : 33401-2208
Country : US
Telephone Number : 561-881-2822
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2017
Last Update Date : 12/07/2017

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Directions to “ NICOLE FONG ” Practice Location

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