Healthcare Provider Details

I. General information

NPI: 1912258153
Provider Name (Legal Business Name): NICOLLE SAINT-FELIX RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2012
Last Update Date: 09/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 12TH AVE SUITE 2005
MIAMI FL
33136-1003
US

IV. Provider business mailing address

1998 NE 176TH ST
NORTH MIAMI BEACH FL
33162-2232
US

V. Phone/Fax

Practice location:
  • Phone: 305-689-6725
  • Fax: 305-689-1133
Mailing address:
  • Phone: 305-947-7830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH12603
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: