Healthcare Provider Details

I. General information

NPI: 1750490819
Provider Name (Legal Business Name): NICOLE MARIE NEIDHART ARNP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE MARIE THOMASNEIDHART ARNP, CNM

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15537 WHISPERING FIR DR
JACKSONVILLE FL
32218-1346
US

IV. Provider business mailing address

15537 WHISPERING FIR DR
JACKSONVILLE FL
32218-1346
US

V. Phone/Fax

Practice location:
  • Phone: 904-371-6724
  • Fax: 904-371-6724
Mailing address:
  • Phone: 904-371-6724
  • Fax: 904-371-6724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number3317462
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number3317462
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: