Provider Demographics
NPI:1225073851
Name:YELLIN, NIKOLE (RD, LD/N)
Entity Type:Individual
Prefix:MRS
First Name:NIKOLE
Middle Name:
Last Name:YELLIN
Suffix:
Gender:F
Credentials:RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11679 NW 12TH ST
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-4102
Mailing Address - Country:US
Mailing Address - Phone:954-346-0102
Mailing Address - Fax:
Practice Address - Street 1:11679 NW 12TH ST
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-4102
Practice Address - Country:US
Practice Address - Phone:954-346-0102
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 3668133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered