Healthcare Provider Details

I. General information

NPI: 1326826959
Provider Name (Legal Business Name): NICOLE FREEDE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2023
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13531 STATE ROAD 54
ODESSA FL
33556-3527
US

IV. Provider business mailing address

8293 BIRCH HAVEN LN
NEW PORT RICHEY FL
34655-5520
US

V. Phone/Fax

Practice location:
  • Phone: 813-925-1903
  • Fax:
Mailing address:
  • Phone: 843-333-6995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: