Healthcare Provider Details

I. General information

NPI: 1013737824
Provider Name (Legal Business Name): NICOLE MARIE GIANFALLA REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13800 VETERANS WAY
ORLANDO FL
32827-7401
US

IV. Provider business mailing address

317 FOREST AVE
ALTAMONTE SPRINGS FL
32701-3615
US

V. Phone/Fax

Practice location:
  • Phone: 407-631-0100
  • Fax:
Mailing address:
  • Phone: 407-341-7683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN9413632
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: