Healthcare Provider Details

I. General information

NPI: 1518800408
Provider Name (Legal Business Name): NICOLE DANIELLE FRAUMENI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2955 PINEDA PLAZA WAY STE 105
MELBOURNE FL
32940-7306
US

IV. Provider business mailing address

2955 PINEDA PLAZA WAY STE 105
MELBOURNE FL
32940-7306
US

V. Phone/Fax

Practice location:
  • Phone: 321-441-4304
  • Fax: 888-440-2093
Mailing address:
  • Phone: 321-441-4304
  • Fax: 888-440-2093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN11046650
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberAPRN11046650
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11046650
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11046650
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: