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General NPI Number Information
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NPI Number | 1841896438
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Entity Type | Individual
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Provider Name | NICOLE MARIE TRYON
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Gender | Female
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Dates
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Enumeration Date | 12/08/2020
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Last Update Date | 02/19/2021
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Provider Practice Location Address
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Address Line | 663 SW GLEN CREST WAY
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City | STUART
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State | FL
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Zip | 34997-7255
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Country | US
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Telephone | 561-818-9812
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Fax |
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Provider Business Mailing Address
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Address Line | 663 SW GLEN CREST WAY
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City | STUART
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State | FL
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Zip | 34997-7255
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11011729
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9355230
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License Number State | FL
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