Healthcare Provider Details

I. General information

NPI: 1568096550
Provider Name (Legal Business Name): DENISE MARIE NICELY WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2020
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 CELEBRATION PL STE 200
CELEBRATION FL
34747-5432
US

IV. Provider business mailing address

11520 DANCING RIVER DR
VENICE FL
34292-4124
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-4220
  • Fax:
Mailing address:
  • Phone: 513-571-7934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN9172211
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: