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General NPI Number Information
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NPI Number | 1750490819
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Entity Type | Individual
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Provider Name | NICOLE MARIE NEIDHART ARNP, CNM
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Gender | Female
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 45088 TACKEL LN
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City | CALLAHAN
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State | FL
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Zip | 32011-6692
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Country | US
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Telephone | 904-371-6724
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Fax | 904-371-6724
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Provider Business Mailing Address
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Address Line | PO BOX 1506
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City | CALLAHAN
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State | FL
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Zip | 32011-1506
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Country | US
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Telephone | 904-371-6724
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Fax | 904-371-6724
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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 | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 3317462
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 3317462
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License Number State | FL
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