Healthcare Provider Details

I. General information

NPI: 1215857164
Provider Name (Legal Business Name): NICOLE CONSUELO PADILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 ASHLEY OAKS CIR # 101
WESLEY CHAPEL FL
33544-6402
US

IV. Provider business mailing address

2970 LIVING CORAL DR
ODESSA FL
33556-5126
US

V. Phone/Fax

Practice location:
  • Phone: 210-885-0002
  • Fax:
Mailing address:
  • Phone: 210-885-0002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number2030
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: