Healthcare Provider Details

I. General information

NPI: 1700716388
Provider Name (Legal Business Name): NICOLE LIM PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 05/23/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 100176
GAINESVILLE FL
32610-0176
US

IV. Provider business mailing address

234 SARATOGA BLVD E
ROYAL PALM BEACH FL
33411-8281
US

V. Phone/Fax

Practice location:
  • Phone: 352-294-8150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: