Basic Information
| Provider Information | |||||||||
| NPI: | 1285992685 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MYERS | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | ELAINE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5003 MISTY PARK LN | ||||||||
| Address2: | |||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774793868 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152926595 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6110 STATE ROAD 70 E | ||||||||
| Address2: | |||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342039712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417554242 | ||||||||
| FaxNumber: | 9417551906 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2012 | ||||||||
| LastUpdateDate: | 06/13/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS11881 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | Q4222 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 204D00000X | OS11881 | FL | Y | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine & OMM |
No ID Information.