Healthcare Provider Details

I. General information

NPI: 1417737024
Provider Name (Legal Business Name): NICOLE ELIZABETH WHITING LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 COLLIER PKWY STE C
LUTZ FL
33549-8718
US

IV. Provider business mailing address

1845 COLLIER PKWY STE C
LUTZ FL
33549-8718
US

V. Phone/Fax

Practice location:
  • Phone: 813-461-3844
  • Fax:
Mailing address:
  • Phone: 813-461-3844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW450
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: