Healthcare Provider Details

I. General information

NPI: 1124590757
Provider Name (Legal Business Name): NICOLE BASILE MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2018
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N DIXIE HWY STE 304
WEST PALM BEACH FL
33401-2717
US

IV. Provider business mailing address

1500 N DIXIE HWY STE 304
WEST PALM BEACH FL
33401-2717
US

V. Phone/Fax

Practice location:
  • Phone: 561-475-5700
  • Fax:
Mailing address:
  • Phone: 561-475-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICOLE ANN BASILE
Title or Position: OWNER
Credential: MD
Phone: 561-475-5700