Healthcare Provider Details

I. General information

NPI: 1548321284
Provider Name (Legal Business Name): NIKKI H NAZARIO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 S ORANGE AVE
ORLANDO FL
32806-2134
US

IV. Provider business mailing address

PO BOX 628296
ORLANDO FL
32862-8296
US

V. Phone/Fax

Practice location:
  • Phone: 407-841-5111
  • Fax: 904-346-0113
Mailing address:
  • Phone: 407-741-9418
  • Fax: 904-346-0113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN3292972
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: