Provider Demographics
NPI:1205182862
Name:NOLES, NICOLE ANGELIQUE (DOM)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ANGELIQUE
Last Name:NOLES
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ANGELIQUE
Other - Last Name:BREDFELDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7029 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-5552
Mailing Address - Country:US
Mailing Address - Phone:941-661-9113
Mailing Address - Fax:
Practice Address - Street 1:7029 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-5552
Practice Address - Country:US
Practice Address - Phone:941-661-9113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3128171100000X
FLMA35332225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist