Provider Demographics
NPI:1184633224
Name:TAYLOR, NICOLE ALYASSA (MS)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ALYASSA
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 SW 27TH AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-4741
Mailing Address - Country:US
Mailing Address - Phone:305-398-6100
Mailing Address - Fax:305-757-4465
Practice Address - Street 1:99 NW 183RD ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-4502
Practice Address - Country:US
Practice Address - Phone:305-652-2874
Practice Address - Fax:305-652-8528
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 8216101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health