Healthcare Provider Details

I. General information

NPI: 1871248070
Provider Name (Legal Business Name): NICOLE LYNN RHODES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2022
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 S TUTTLE AVE
SARASOTA FL
34239-2608
US

IV. Provider business mailing address

157 BALTIMORE ST STE 102
CUMBERLAND MD
21502-2472
US

V. Phone/Fax

Practice location:
  • Phone: 301-722-0484
  • Fax: 833-903-0130
Mailing address:
  • Phone: 301-722-0484
  • Fax: 833-903-0130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11031392
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: