MEDICARE: NICOLE CHRISTINE FORBES

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	103K00000X	Behavior Analyst	1-13-14881

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659627081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE CHRISTINE FORBES

Provider Business Mailing Address
First Line	:	3500 DEPAUW BLVD STE 3070
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-6135
Country	:	US
Telephone Number	:	463-223-4591
Fax Number	:	317-520-8200

Provider Business Practice Location Address
First Line	:	6909 OLD HIGHWAY 441 S STE 119
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-7039
Country	:	US
Telephone Number	:	352-358-5001
Fax Number	:	317-520-8200

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

Provider Enumeration Date	:	08/03/2012
Last Update Date	:	06/20/2023

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Directions to “ NICOLE CHRISTINE FORBES ” Practice Location

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