Healthcare Provider Details

I. General information

NPI: 1699696989
Provider Name (Legal Business Name): NICHOLAS ESTEFAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 S UNIVERSITY DR STE 121
PLANTATION FL
33324-3318
US

IV. Provider business mailing address

425 VILABELLA AVE
CORAL GABLES FL
33146-1715
US

V. Phone/Fax

Practice location:
  • Phone: 954-477-7455
  • Fax:
Mailing address:
  • Phone: 305-562-2183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMT4283
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: