Provider Demographics
NPI:1417371220
Name:KOBY, NICHOLE A E
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:A E
Last Name:KOBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:A E
Other - Last Name:HUDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4217 CENTERGATE LN APT 201
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-6085
Mailing Address - Country:US
Mailing Address - Phone:352-359-1566
Mailing Address - Fax:
Practice Address - Street 1:926 GREAT POND DR STE 1000
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-7244
Practice Address - Country:US
Practice Address - Phone:407-862-0444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN205061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice