Healthcare Provider Details

I. General information

NPI: 1184083032
Provider Name (Legal Business Name): NICHOLAS PATRICK CIFERNO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2016
Last Update Date: 02/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2814 S US HIGHWAY 1 STE D4
FORT PIERCE FL
34982-8110
US

IV. Provider business mailing address

437 CONCHA DR
SEBASTIAN FL
32958-6503
US

V. Phone/Fax

Practice location:
  • Phone: 772-489-4726
  • Fax:
Mailing address:
  • Phone: 303-328-1161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: