MEDICARE: CANDICE D MARTENS NICOLL ARNP

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	363LF0000X	Family Nurse Practitioner	ARNP3382212	FL

General Provider Information

NPI Number	:	1669798641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDICE D MARTENS NICOLL ARNP

Provider Business Mailing Address
First Line	:	3434 HANCOCK BRIDGE PKWY
Second Line	:
City	:	N FT MYERS
State	:	FL
Zip	:	33903-7094
Country	:	US
Telephone Number	:	877-856-3774
Fax Number	:	239-599-2625

Provider Business Practice Location Address
First Line	:	2975 BOBCAT VILLAGE CENTER RD
Second Line	:	STE. 100
City	:	NORTH PORT
State	:	FL
Zip	:	34288-4600
Country	:	US
Telephone Number	:	941-423-9936
Fax Number	:	941-426-9794

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

Provider Enumeration Date	:	04/15/2010
Last Update Date	:	09/28/2016

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