Provider Demographics
NPI:1043312556
Name:IOVINE, NICOLE M (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:M
Last Name:IOVINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-392-4058
Mailing Address - Fax:352-392-6481
Practice Address - Street 1:1601 SW ARCHER RD
Practice Address - Street 2:ROOM A252-1
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-392-4058
Practice Address - Fax:352-392-6481
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY221898207RI0200X
FLME 105641207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001536400Medicaid
FL001536400Medicaid