MEDICARE: NICOLE SCHULTZ APRN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	SP011422	PA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	ARNP9298519	FL
3	163W00000X	Registered Nurse	621101	PA

General Provider Information

NPI Number	:	1538451703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE SCHULTZ APRN

Provider Business Mailing Address
First Line	:	1565 N HARBOR CITY BLVD
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32935-6568
Country	:	US
Telephone Number	:	321-638-6818
Fax Number	:	321-616-8126

Provider Business Practice Location Address
First Line	:	1565 N HARBOR CITY BLVD
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32935-6568
Country	:	US
Telephone Number	:	321-638-6818
Fax Number	:	321-616-8126

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

Provider Enumeration Date	:	05/06/2011
Last Update Date	:	06/03/2026

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