Healthcare Provider Details

I. General information

NPI: 1437440559
Provider Name (Legal Business Name): NICOLE B MEISNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2011
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 S KANNER HWY
STUART FL
34994-7204
US

IV. Provider business mailing address

1815 S KANNER HWY
STUART FL
34994-7204
US

V. Phone/Fax

Practice location:
  • Phone: 772-288-2992
  • Fax: 772-288-2999
Mailing address:
  • Phone: 722-882-9927
  • Fax: 772-288-2999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME168409
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: