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General NPI Number Information
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NPI Number | 1578248522
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Entity Type | Individual
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Provider Name | NICOLE ANN DELLA PORTA AA
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Gender | Female
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Dates
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Enumeration Date | 06/19/2023
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Last Update Date | 02/18/2024
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Provider Practice Location Address
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Address Line | 2601 S BLAIR STONE RD STE GC3
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City | TALLAHASSEE
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State | FL
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Zip | 32301-5939
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Country | US
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Telephone | 850-385-0144
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Fax |
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Provider Business Mailing Address
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Address Line | 5000 N OCEAN BLVD # Q204
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City | BRINY BREEZES
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State | FL
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Zip | 33435-7341
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Country | US
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Telephone | 561-634-1387
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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 | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number | AA885
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License Number State | FL
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