MEDICARE: NICOLE MARIE NEIDHART ARNP, CNM

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	367A00000X	Advanced Practice Midwife	3317462	FL
2	363LW0102X	Women's Health Nurse Practitioner	3317462	FL

General Provider Information

NPI Number	:	1750490819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MARIE NEIDHART ARNP, CNM

Provider Business Mailing Address
First Line	:	15537 WHISPERING FIR DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-1346
Country	:	US
Telephone Number	:	904-371-6724
Fax Number	:	904-371-6724

Provider Business Practice Location Address
First Line	:	15537 WHISPERING FIR DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-1346
Country	:	US
Telephone Number	:	904-371-6724
Fax Number	:	904-371-6724

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	05/28/2026

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