Healthcare Provider Details

I. General information

NPI: 1336003383
Provider Name (Legal Business Name): NYCOLE KAUK PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34715 ORANGE BELT DR
DADE CITY FL
33523-6484
US

IV. Provider business mailing address

30929 MIRADA BLVD # 940
SAN ANTONIO FL
33576-7306
US

V. Phone/Fax

Practice location:
  • Phone: 727-331-2388
  • Fax:
Mailing address:
  • Phone: 727-331-2388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBACB473975
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA2444
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY12910
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: