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General NPI Number Information
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NPI Number | 1801821996
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Entity Type | Individual
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Provider Name | JULIE A NICOLETTA M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 07/08/2024
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Provider Practice Location Address
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Address Line | 4510 PGA BLVD STE 101
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33418-3968
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Country | US
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Telephone | 561-627-7930
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Fax |
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Provider Business Mailing Address
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Address Line | 13256 MACHIAVELLI WAY
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33418-6196
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Country | US
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Telephone | 781-489-5141
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 212653
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME156048
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License Number State | FL
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