Healthcare Provider Details

I. General information

NPI: 1013367531
Provider Name (Legal Business Name): NICOLE HARTWICK RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 PINE RIDGE RD STE 19
NAPLES FL
34109-2110
US

IV. Provider business mailing address

1575 PINE RIDGE RD STE 19
NAPLES FL
34109-2110
US

V. Phone/Fax

Practice location:
  • Phone: 239-593-0663
  • Fax:
Mailing address:
  • Phone: 239-593-0663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND 6154
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: