MEDICARE: NICOLE VENABLE 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	363LG0600X	Gerontology Nurse Practitioner	11047994	FL

General Provider Information

NPI Number	:	1689508483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE VENABLE APRN

Provider Business Mailing Address
First Line	:	276 MISSISSIPPI WOODS LN
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32824-8688
Country	:	US
Telephone Number	:	407-615-0554
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 LUCIEN WAY STE 100
Second Line	:
City	:	MAITLAND
State	:	FL
Zip	:	32751-7003
Country	:	US
Telephone Number	:	407-875-0028
Fax Number	:

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

Provider Enumeration Date	:	06/09/2026
Last Update Date	:	06/09/2026

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