Provider Demographics
NPI:1013367531
Name:HARTWICK, NICOLE (RDN)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:HARTWICK
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 PINE RIDGE RD STE 19
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-2110
Mailing Address - Country:US
Mailing Address - Phone:239-593-0663
Mailing Address - Fax:
Practice Address - Street 1:1575 PINE RIDGE RD STE 19
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-2110
Practice Address - Country:US
Practice Address - Phone:239-593-0663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 6154133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered