Healthcare Provider Details

I. General information

NPI: 1043312556
Provider Name (Legal Business Name): NICOLE M. IOVINE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2006
Last Update Date: 01/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD ROOM A252-1
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

PO BOX 918025
ORLANDO FL
32891-8025
US

V. Phone/Fax

Practice location:
  • Phone: 352-392-4058
  • Fax: 352-392-6481
Mailing address:
  • Phone: 352-392-4058
  • Fax: 352-392-6481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number221898
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME 105641
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: