Healthcare Provider Details

I. General information

NPI: 1124759428
Provider Name (Legal Business Name): NIKOLINA CVETKOVSKA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2022
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 BEDFORD DR STE 102
MELBOURNE FL
32940-1993
US

IV. Provider business mailing address

1370 BEDFORD DR STE 102
MELBOURNE FL
32940-1993
US

V. Phone/Fax

Practice location:
  • Phone: 321-622-8104
  • Fax: 321-574-4046
Mailing address:
  • Phone: 321-622-8104
  • Fax: 321-574-4046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH29144
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: