Provider Demographics
NPI:1114631264
Name:ARENDT, NICOLLE (LM, CPM)
Entity Type:Individual
Prefix:
First Name:NICOLLE
Middle Name:
Last Name:ARENDT
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 SADDLERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-5394
Mailing Address - Country:US
Mailing Address - Phone:407-401-3968
Mailing Address - Fax:
Practice Address - Street 1:215 LITHIA PINECREST RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5307
Practice Address - Country:US
Practice Address - Phone:813-685-8404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL442176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife