Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 11007636 | FL |
NPI | 1003432758 |
---|---|
Provider Name | Nicole K Rodolpho |
First Address | Boca Raton, FL 33432-4931 |
Second Address | Fort Lauderdale, FL 33308-2226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2020 |
Last Update Date | 18/06/2020 |