Provider Demographics
NPI:1043217425
Name:HANCOCK, NICOLE D (DPM)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:D
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:D
Other - Last Name:KLUEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:1330 CITIZENS BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-3959
Mailing Address - Country:US
Mailing Address - Phone:352-728-1252
Mailing Address - Fax:352-728-0079
Practice Address - Street 1:1330 CITIZENS BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-3959
Practice Address - Country:US
Practice Address - Phone:352-728-1252
Practice Address - Fax:352-728-0079
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3581213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
8AD031OtherBLUE CROSS/BLUE SHIELD
00X950Medicare PIN
8AD031OtherBLUE CROSS/BLUE SHIELD