Basic Information
| Provider Information | |||||||||
| NPI: | 1427660349 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARSHALL | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | THERESA | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 CLEMATIS ST STE 5-531 | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334015107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616714036 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1250 SOUTHWINDS DR | ||||||||
| Address2: | |||||||||
| City: | LANTANA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334621459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5615476800 | ||||||||
| FaxNumber: | 5615476865 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2020 | ||||||||
| LastUpdateDate: | 05/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 11008737 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.