Provider Demographics
NPI:1275538126
Name:FLORA, NICOLE R (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:R
Last Name:FLORA
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 98978
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8978
Mailing Address - Country:US
Mailing Address - Phone:702-507-2430
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:3201 S MARYLAND PKWY
Practice Address - Street 2:SUITE 400
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2441
Practice Address - Country:US
Practice Address - Phone:702-262-1130
Practice Address - Fax:702-262-1161
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV12743207Q00000X
OH35077148207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1275538126Medicaid
NV1275538126Medicaid
NVBE529YMedicare PIN