MEDICARE: NICOLE FITZPATRICK LCSW

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	101YM0800X	Mental Health Counselor	SW25600	FL

General Provider Information

NPI Number	:	1194694463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE FITZPATRICK LCSW

Provider Business Mailing Address
First Line	:	324 NW 18TH ST
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33993-5166
Country	:	US
Telephone Number	:	239-347-3193
Fax Number	:

Provider Business Practice Location Address
First Line	:	3434 HANCOCK BRIDGE PKWY STE 205
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33903-7005
Country	:	US
Telephone Number	:	239-347-3193
Fax Number	:

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

Provider Enumeration Date	:	11/04/2025
Last Update Date	:	11/04/2025

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