Provider Demographics
NPI:1609038702
Name:FIGUEREDO, NICOLE D (MD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:D
Last Name:FIGUEREDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:D
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:38135 MARKET SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7505
Mailing Address - Country:US
Mailing Address - Phone:813-315-1521
Mailing Address - Fax:813-355-5008
Practice Address - Street 1:1721 BRANDON MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5018
Practice Address - Country:US
Practice Address - Phone:813-315-1521
Practice Address - Fax:813-355-5008
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08657300208600000X
FLME131521208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021915300Medicaid
NJ0217450Medicaid
NJ0217450Medicaid