MEDICARE: NICOLE AYUSO

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	225100000X	Physical Therapist	PT 30098	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	:	1710341540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE AYUSO

Provider Business Mailing Address
First Line	:	5816 FISHHAWK RIDGE DR
Second Line	:
City	:	LITHIA
State	:	FL
Zip	:	33547-3821
Country	:	US
Telephone Number	:	917-622-3794
Fax Number	:

Provider Business Practice Location Address
First Line	:	6508 GUNN HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-4022
Country	:	US
Telephone Number	:	813-963-6923
Fax Number	:	813-264-0768

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

Provider Enumeration Date	:	04/07/2016
Last Update Date	:	03/24/2026

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Directions to “ NICOLE AYUSO ” Practice Location

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