Healthcare Provider Details

I. General information

NPI: 1740542877
Provider Name (Legal Business Name): LIZABETH NONELL SAINT-HILAIRE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LIZABETH ROSALIA NONELL M.D.

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 MINTON RD NW STE 202
PALM BAY FL
32907-1900
US

IV. Provider business mailing address

6100 MINTON RD NW STE 202
PALM BAY FL
32907-1900
US

V. Phone/Fax

Practice location:
  • Phone: 321-308-0601
  • Fax: 321-308-0598
Mailing address:
  • Phone: 321-308-0601
  • Fax: 321-308-0598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME123119
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: