MEDICARE: NICOLE MARIE SANTAMORE BCBA

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
1	103K00000X	Behavior Analyst	1-23-63664	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1568969798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MARIE SANTAMORE BCBA

Provider Business Mailing Address
First Line	:	3061 DAGGET AVE SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-8113
Country	:	US
Telephone Number	:	321-408-6393
Fax Number	:	321-343-3784

Provider Business Practice Location Address
First Line	:	3061 DAGGET AVE SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-8113
Country	:	US
Telephone Number	:	321-408-6393
Fax Number	:	321-343-3784

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2018
Last Update Date	:	05/08/2025

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