MEDICARE: DR. NICOLE MARIE FIELDS

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	183500000X	Pharmacist	PS42434	FL

General Provider Information

NPI Number	:	1750592671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE MARIE FIELDS

Provider Business Mailing Address
First Line	:	911 LAMPLIGHTER DR NW
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32907
Country	:	US
Telephone Number	:	321-327-4757
Fax Number	:

Provider Business Practice Location Address
First Line	:	3799 MURRELL RD
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-4710
Country	:	US
Telephone Number	:	321-631-2755
Fax Number	:

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	09/27/2007

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