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NPI Code Detail

MEDICARE: NICOLE M FOURQUET DRA.

MEDICARE: NICOLE M FOURQUET DRA.
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
1103TC2200XClinical Child & Adolescent Psychologist8722PR
2103TC0700XClinical Psychologist8722PR

General Provider Information

NPI Number : 1811851959
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE M FOURQUET DRA.
Provider Business Mailing Address
First Line : URB. VEREDAS DE YAUCO, CALLE SENDERO #104
Second Line :
City : YAUCO
State : PR
Zip : 00698
Country : US
Telephone Number : 787-637-1408
Fax Number :
Provider Business Practice Location Address
First Line : 1123 AVE HOSTOS
Second Line :
City : PONCE
State : PR
Zip : 00717-0952
Country : US
Telephone Number : 787-637-1408
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2025
Last Update Date : 12/12/2025

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