Healthcare Provider Details

I. General information

NPI: 1659361988
Provider Name (Legal Business Name): NICOLE A COWETTE C-PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 05/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 37TH ST
VERO BEACH FL
32960-4863
US

IV. Provider business mailing address

1600 37TH ST
VERO BEACH FL
32960-4863
US

V. Phone/Fax

Practice location:
  • Phone: 772-766-0789
  • Fax: 772-581-3991
Mailing address:
  • Phone: 772-766-0789
  • Fax: 772-581-3991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9102638
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: