Healthcare Provider Details

I. General information

NPI: 1679880355
Provider Name (Legal Business Name): NICOLE BROOKE NEWMYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E ROLLINS ST
ORLANDO FL
32803-1248
US

IV. Provider business mailing address

PO BOX 198441 SUITE 201
ATLANTA GA
30384-8441
US

V. Phone/Fax

Practice location:
  • Phone: 407-667-0444
  • Fax: 407-667-4338
Mailing address:
  • Phone: 813-745-7365
  • Fax: 813-449-8618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9237951
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: