Healthcare Provider Details

I. General information

NPI: 1760768626
Provider Name (Legal Business Name): NICOLE MARIE PRETET-FALCO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2011
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9611 W BROWARD BLVD
PLANTATION FL
33324-2334
US

IV. Provider business mailing address

7110 W 127TH ST ST #130
PALOS HEIGHTS IL
60463-1571
US

V. Phone/Fax

Practice location:
  • Phone: 954-924-7000
  • Fax:
Mailing address:
  • Phone: 708-923-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.132794
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS15726
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: