Healthcare Provider Details

I. General information

NPI: 1407164452
Provider Name (Legal Business Name): NICOLE JENNIFER SCALLATINO RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2010
Last Update Date: 11/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE SUITE 442
ORLANDO FL
32804-4603
US

IV. Provider business mailing address

2501 N ORANGE AVE SUITE 442
ORLANDO FL
32804
US

V. Phone/Fax

Practice location:
  • Phone: 407-405-0943
  • Fax:
Mailing address:
  • Phone: 407-405-0943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN 9203072
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: