Provider Demographics
NPI:1376975565
Name:PIEDIMONTE, NICOLE L (PA-C)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:L
Last Name:PIEDIMONTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7850 CROSSWATER TRL
Mailing Address - Street 2:APT 2 -206
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10743 NARCOOSSEE ROAD
Practice Address - Street 2:SUITE A-18
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832
Practice Address - Country:US
Practice Address - Phone:407-277-1900
Practice Address - Fax:407-277-1888
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA13351363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical