Healthcare Provider Details

I. General information

NPI: 1790227494
Provider Name (Legal Business Name): NICOLE A SHAFAR ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE A SHAFAR ARNP

II. Dates (important events)

Enumeration Date: 11/11/2016
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7649 W COLONIAL DR STE 115
ORLANDO FL
32818-7423
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 200
MIAMI FL
33126-3168
US

V. Phone/Fax

Practice location:
  • Phone: 407-522-2080
  • Fax: 833-963-0115
Mailing address:
  • Phone: 305-500-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberARNP9309557
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: