Healthcare Provider Details

I. General information

NPI: 1922444231
Provider Name (Legal Business Name): NICOLE D TAUBEL DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 05/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 W NEWBERRY RD
GAINESVILLE FL
32607-2249
US

IV. Provider business mailing address

173 SUMMER POINT DR
SAINT AUGUSTINE FL
32086-1846
US

V. Phone/Fax

Practice location:
  • Phone: 352-264-2499
  • Fax:
Mailing address:
  • Phone: 352-316-5974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 28240
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: