Healthcare Provider Details

I. General information

NPI: 1780902494
Provider Name (Legal Business Name): NICOLE THERESA CACHO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER ROAD SHANDS HOSPITAL
GAINESVILLE FL
32607
US

IV. Provider business mailing address

UF DIVISION OF NEONATOLOGY P.O. BOX 100296
GAINESVILLE FL
32610-0296
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-8985
  • Fax: 352-273-9054
Mailing address:
  • Phone: 352-273-8985
  • Fax: 352-273-9054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberUO2347
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberOS12231
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: