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General NPI Number Information
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NPI Number | 1437868403
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Entity Type | Individual
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Provider Name | NICKENSON CETOUTE APRN
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Gender | Male
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Dates
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Enumeration Date | 11/18/2022
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Last Update Date | 01/12/2023
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Provider Practice Location Address
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Address Line | 7000 H C KELLEY RD
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City | ORLANDO
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State | FL
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Zip | 32831-2518
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Country | US
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Telephone | 407-207-7777
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Fax |
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Provider Business Mailing Address
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Address Line | 3287 SUGAR BERRY WAY
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City | TALLAHASSEE
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State | FL
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Zip | 32303-7371
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Country | US
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Telephone | 786-704-7952
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN11022673
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License Number State | FL
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