Healthcare Provider Details

I. General information

NPI: 1487919668
Provider Name (Legal Business Name): DEBORAH TERESA NICOLO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GLAM SQUAD,LLC DBA NURSE ON CALL RN

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12120 ROSELAND DR
NEW PORT RICHEY FL
34654-6316
US

IV. Provider business mailing address

12120 ROSELAND DR
NEW PORT RICHEY FL
34654-6316
US

V. Phone/Fax

Practice location:
  • Phone: 727-226-7844
  • Fax:
Mailing address:
  • Phone: 727-226-7844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9533054
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: