Healthcare Provider Details

I. General information

NPI: 1730014895
Provider Name (Legal Business Name): NICOLE GEDEON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10155 SE 110TH STREET RD
BELLEVIEW FL
34420-3694
US

IV. Provider business mailing address

2990 FOXTAIL BND
OCOEE FL
34761-8473
US

V. Phone/Fax

Practice location:
  • Phone: 407-717-0343
  • Fax: 321-325-1034
Mailing address:
  • Phone: 407-970-1424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number10505
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: