Healthcare Provider Details

I. General information

NPI: 1356272785
Provider Name (Legal Business Name): NICOLE MARIE PIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8260 W 18TH LN
HIALEAH FL
33014-3244
US

IV. Provider business mailing address

8260 W 18TH LN
HIALEAH FL
33014-3244
US

V. Phone/Fax

Practice location:
  • Phone: 305-401-8464
  • Fax:
Mailing address:
  • Phone: 305-401-8464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9671791
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: