Healthcare Provider Details

I. General information

NPI: 1609663137
Provider Name (Legal Business Name): NICOLE ARNESON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 W SWANN AVE STE 100
TAMPA FL
33606-2478
US

IV. Provider business mailing address

5059 BROMELIAD AVE
WIMAUMA FL
33598-4281
US

V. Phone/Fax

Practice location:
  • Phone: 813-251-1618
  • Fax:
Mailing address:
  • Phone: 864-516-6676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT27459
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: