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General NPI Number Information
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NPI Number | 1568096550
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Entity Type | Individual
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Provider Name | DENISE MARIE NICELY WHNP
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Gender | Female
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Dates
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Enumeration Date | 02/27/2020
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Last Update Date | 02/09/2024
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Provider Practice Location Address
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Address Line | 410 CELEBRATION PL STE 200
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City | CELEBRATION
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State | FL
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Zip | 34747-5432
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Country | US
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Telephone | 407-303-4220
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Fax |
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Provider Business Mailing Address
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Address Line | 11520 DANCING RIVER DR
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City | VENICE
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State | FL
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Zip | 34292-4124
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Country | US
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Telephone | 513-571-7934
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | APRN9172211
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License Number State | FL
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