MEDICARE: NICOLE ANN POWER DMD

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	1223G0001X	General Practice Dentistry	27951	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	:	1174217574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE ANN POWER DMD

Provider Business Mailing Address
First Line	:	13401 GOLF CREST WAY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-8621
Country	:	US
Telephone Number	:	813-961-8079
Fax Number	:

Provider Business Practice Location Address
First Line	:	1912 W REYNOLDS ST
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33563-4700
Country	:	US
Telephone Number	:	813-567-7001
Fax Number	:

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

Provider Enumeration Date	:	06/07/2023
Last Update Date	:	06/07/2023

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Directions to “ NICOLE ANN POWER DMD” Practice Location

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