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NPI Code Detail

MEDICARE: NICOLE M BEDELL

MEDICARE:   NICOLE M BEDELL
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
1124Q00000XDental Hygienist26887FL

General Provider Information

NPI Number : 1629672670
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE M BEDELL
Provider Business Mailing Address
First Line : 3802 CARROLLWOOD PLACE CIR APT 208
Second Line :
City : TAMPA
State : FL
Zip : 33624-3054
Country : US
Telephone Number : 802-881-2447
Fax Number :
Provider Business Practice Location Address
First Line : 13584 UNIVERSITY PLAZA ST
Second Line :
City : TAMPA
State : FL
Zip : 33613-4628
Country : US
Telephone Number : 813-971-8141
Fax Number : 813-972-0978
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2020
Last Update Date : 11/30/2020

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Directions to “ NICOLE M BEDELL ” Practice Location

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