Healthcare Provider Details

I. General information

NPI: 1184069494
Provider Name (Legal Business Name): NICOLE E TAFURI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 06/12/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1381 S PATRICK DR
PATRICK AFB FL
32925-3606
US

IV. Provider business mailing address

45TH MEDICAL GROUP 1381 SOUTH PATRICK DR
PATRICK AFB FL
32925
US

V. Phone/Fax

Practice location:
  • Phone: 850-559-9557
  • Fax:
Mailing address:
  • Phone: 321-494-8251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: