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General NPI Number Information
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NPI Number | 1184991804
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Entity Type | Individual
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Provider Name | NICOLE BERNARD LMT
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Gender | Female
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Dates
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Enumeration Date | 11/23/2011
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Last Update Date | 11/23/2011
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Provider Practice Location Address
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Address Line | 805 S KIRKMAN RD STE 207
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City | ORLANDO
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State | FL
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Zip | 32811-2200
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Country | US
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Telephone | 407-295-6665
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Fax |
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Provider Business Mailing Address
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Address Line | 5234 N ORANGE BLOSSOM TRL APT 305
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City | ORLANDO
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State | FL
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Zip | 32810-1085
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Country | US
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Telephone | 407-300-0963
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | MA58018
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License Number State | FL
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