Healthcare Provider Details

I. General information

NPI: 1629813159
Provider Name (Legal Business Name): NICHOLAS MARTIN FIELD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9970 S. CENTRAL PARK BOULEVARD SUITE 401
BOCA RATON FL
33428
US

IV. Provider business mailing address

9970 CENTRAL PARK BLVD N STE 401
BOCA RATON FL
33428-2252
US

V. Phone/Fax

Practice location:
  • Phone: 305-807-1909
  • Fax:
Mailing address:
  • Phone: 305-807-1909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-258992
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: