Provider Demographics
NPI:1407130545
Name:POWERS, NICOLE (APRN)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:POWERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:POWERS
Other - Last Name:DEBOSKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:18536 MERSEYSIDE LOOP
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-7956
Mailing Address - Country:US
Mailing Address - Phone:813-475-6792
Mailing Address - Fax:866-404-2708
Practice Address - Street 1:18536 MERSEYSIDE LOOP
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-7956
Practice Address - Country:US
Practice Address - Phone:813-527-0882
Practice Address - Fax:866-404-2708
Is Sole Proprietor?:No
Enumeration Date:2011-10-07
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9186467163WP0808X
FLARNP9186467363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004209001Medicaid
FLFV698WMedicare PIN
FLFV698XMedicare PIN