Healthcare Provider Details

I. General information

NPI: 1376999656
Provider Name (Legal Business Name): NICOLE COHEN M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20900 BISCAYNE BLVD
AVENTURA FL
33180-1495
US

IV. Provider business mailing address

511 IVES DAIRY RD APT F-406
MIAMI FL
33179-5486
US

V. Phone/Fax

Practice location:
  • Phone: 305-962-8149
  • Fax:
Mailing address:
  • Phone: 786-489-2522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME147846
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: