Provider Demographics
NPI:1497168330
Name:PALM, NICOLE FLOYD (PA-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:FLOYD
Last Name:PALM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JACQUELYNNE
Other - Middle Name:NICOLE
Other - Last Name:FLOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7800 LAKE UNDERHILL RD
Mailing Address - Street 2:ORLANDO MEDICAL CENTERS
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822
Mailing Address - Country:US
Mailing Address - Phone:407-282-2244
Mailing Address - Fax:
Practice Address - Street 1:7800 LAKE UNDERHILL RD
Practice Address - Street 2:ORLANDO MEDICAL CENTERS
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822
Practice Address - Country:US
Practice Address - Phone:407-282-2244
Practice Address - Fax:407-282-2002
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107536207R00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine