MEDICARE: FEDINE NICOLAS

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	11042792	FL

General Provider Information

NPI Number	:	1588528491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FEDINE NICOLAS

Provider Business Mailing Address
First Line	:	7148 COLONY CLUB DR APT 305
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-7830
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7148 COLONY CLUB DR APT 305
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-7830
Country	:	US
Telephone Number	:	954-803-0501
Fax Number	:

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

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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Directions to “ FEDINE NICOLAS ” Practice Location

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