MEDICARE: MRS. NICOLE PALERMO

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	163W00000X	Registered Nurse	RN9592286	FL
2	363LA2100X	Acute Care Nurse Practitioner	APRN11045040	FL

General Provider Information

NPI Number	:	1477426096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE PALERMO

Provider Business Mailing Address
First Line	:	12856 TRIPOLI AVE
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33579-9447
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12856 TRIPOLI AVE
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33579-9447
Country	:	US
Telephone Number	:	845-480-2228
Fax Number	:	845-480-2228

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

Provider Enumeration Date	:	09/29/2025
Last Update Date	:	03/09/2026

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