MEDICARE: NICOLE TIQUANA CALDWELL C.N.A./P.C.T./M.H.T.

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	376K00000X	Nurse's Aide	C.N.A 127560	FL

General Provider Information

NPI Number	:	1316172083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE TIQUANA CALDWELL C.N.A./P.C.T./M.H.T.

Provider Business Mailing Address
First Line	:	PO BOX 100736
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33310-0736
Country	:	US
Telephone Number	:	954-708-4646
Fax Number	:	754-206-2147

Provider Business Practice Location Address
First Line	:	1200 NW 5TH AVE # 1
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33311-6027
Country	:	US
Telephone Number	:	954-708-4646
Fax Number	:	754-206-2147

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

Provider Enumeration Date	:	05/23/2009
Last Update Date	:	09/11/2025

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