Healthcare Provider Details

I. General information

NPI: 1114631264
Provider Name (Legal Business Name): NICOLLE ARENDT LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2023
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 LITHIA PINECREST RD
BRANDON FL
33511-5307
US

IV. Provider business mailing address

1409 SADDLERIDGE DR
ORLANDO FL
32835-5394
US

V. Phone/Fax

Practice location:
  • Phone: 813-685-8404
  • Fax:
Mailing address:
  • Phone: 407-401-3968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number442
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: