Provider Demographics
NPI:1871600775
Name:ROBICHAUX, NICOLE R (ARNP, PSYD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:R
Last Name:ROBICHAUX
Suffix:
Gender:F
Credentials:ARNP, PSYD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:R
Other - Last Name:KEENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:100 MAIN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-3657
Mailing Address - Country:US
Mailing Address - Phone:727-799-4150
Mailing Address - Fax:727-796-1845
Practice Address - Street 1:100 MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695
Practice Address - Country:US
Practice Address - Phone:727-799-4150
Practice Address - Fax:727-796-1845
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9448103T00000X
FLARNP9351504363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22849700Medicaid
FL767397300Medicaid