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NPI Code Detail

MEDICARE: JULIE A NICOLETTA M.D.

MEDICARE: JULIE A NICOLETTA M.D.
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
1208000000XPediatrics Physician212653MA
2208000000XPediatrics PhysicianME156048FL

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 : 1801821996
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIE A NICOLETTA M.D.
Provider Business Mailing Address
First Line : 13256 MACHIAVELLI WAY
Second Line :
City : PALM BEACH GARDENS
State : FL
Zip : 33418-6196
Country : US
Telephone Number : 781-489-5141
Fax Number :
Provider Business Practice Location Address
First Line : 4510 PGA BLVD STE 101
Second Line :
City : PALM BEACH GARDENS
State : FL
Zip : 33418-3968
Country : US
Telephone Number : 561-627-7930
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2006
Last Update Date : 07/08/2024

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