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General NPI Number Information
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NPI Number | 1508364019
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Entity Type | Individual
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Provider Name | NICOLE PHILLIPS BCBA
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Gender | Female
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Dates
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Enumeration Date | 01/30/2018
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Last Update Date | 11/28/2022
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Provider Practice Location Address
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Address Line | 8053 WEST OAKLAND PARK BLVD SUITE 950
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City | SUNRISE
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State | FL
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Zip | 33351-7776
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Country | US
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Telephone | 754-422-2165
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Fax |
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Provider Business Mailing Address
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Address Line | 8053 W OAKLAND PARK BLVD STE 950
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City | SUNRISE
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State | FL
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Zip | 33351-1162
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Country | US
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Telephone | 754-422-2165
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 12044065
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License Number State | FL
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