Basic Information
| Provider Information | |||||||||
| NPI: | 1174133391 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AULD | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10150 HIGHLAND MANOR DR STE 240 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336109750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132591013 | ||||||||
| FaxNumber: | 8132540396 | ||||||||
| Practice Location | |||||||||
| Address1: | 10150 HIGHLAND MANOR DR STE 240 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336109750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132591013 | ||||||||
| FaxNumber: | 8132540396 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2020 | ||||||||
| LastUpdateDate: | 11/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 9113220 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.