Healthcare Provider Details

I. General information

NPI: 1427640432
Provider Name (Legal Business Name): NICOLE LAFOUNTAIN LA.C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 BREVARD AVE STE 9
COCOA FL
32922-7908
US

IV. Provider business mailing address

313 BREVARD AVE STE 9
COCOA FL
32922-7908
US

V. Phone/Fax

Practice location:
  • Phone: 321-534-4779
  • Fax:
Mailing address:
  • Phone: 321-634-4779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP4563
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: