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General NPI Number Information
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NPI Number | 1215113378
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Entity Type | Individual
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Provider Name | NICOLA A KEMMERER PA
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Gender | Female
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Dates
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Enumeration Date | 01/18/2008
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Last Update Date | 05/07/2024
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Provider Practice Location Address
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Address Line | 100 NW 170TH ST STE 208
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33169-5510
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Country | US
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Telephone | 305-405-0045
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Fax | 305-405-0048
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Provider Business Mailing Address
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Address Line | 6255 W SUNSET BLVD FL 21
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City | LOS ANGELES
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State | CA
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Zip | 90028-7422
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Country | US
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Telephone | 323-860-5200
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Fax | 234-677-1193
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 11757
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9104311
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License Number State | FL
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