Provider Demographics
NPI:1477601144
Name:SOLOMON, NINA SUZANNE (DPM)
Entity Type:Individual
Prefix:DR
First Name:NINA
Middle Name:SUZANNE
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5845 S CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1347
Mailing Address - Country:US
Mailing Address - Phone:561-439-0500
Mailing Address - Fax:561-439-6669
Practice Address - Street 1:5845 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1347
Practice Address - Country:US
Practice Address - Phone:561-439-0500
Practice Address - Fax:561-439-6669
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2154213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390170000Medicaid
FL65300Medicare ID - Type Unspecified
FL390170000Medicaid