Provider Demographics
NPI:1376948190
Name:FOSTER, NICOLE (PA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9970 CENTRAL PARK BLVD N STE 207
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-2236
Mailing Address - Country:US
Mailing Address - Phone:561-487-5506
Mailing Address - Fax:561-487-9261
Practice Address - Street 1:9970 CENTRAL PARK BLVD N STE 207
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-2236
Practice Address - Country:US
Practice Address - Phone:561-487-5506
Practice Address - Fax:561-487-9261
Is Sole Proprietor?:No
Enumeration Date:2014-10-23
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363AS0400X
FLPA9114075363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical