MEDICARE: NICOLE MARIE DIBELLA CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	ARNP9270729	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083005532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MARIE DIBELLA CRNA

Provider Business Mailing Address
First Line	:	7111 FAIRWAY DR STE 450
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-4200
Country	:	US
Telephone Number	:	561-623-2001
Fax Number	:	865-347-5154

Provider Business Practice Location Address
First Line	:	11375 CORTEZ BLVD
Second Line	:
City	:	BROOKSVILLE
State	:	FL
Zip	:	34613-5409
Country	:	US
Telephone Number	:	352-596-6632
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2015
Last Update Date	:	02/27/2020

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