Healthcare Provider Details

I. General information

NPI: 1609935550
Provider Name (Legal Business Name): NICOLE MARRO SEMASKVICH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 N FLORIDA AVE
LAKELAND FL
33805-3109
US

IV. Provider business mailing address

7302 KINARD RD
PLANT CITY FL
33565-3658
US

V. Phone/Fax

Practice location:
  • Phone: 863-904-6201
  • Fax: 866-264-2519
Mailing address:
  • Phone: 813-440-9504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN390
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN9286557
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN9286557
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: