Provider Demographics
NPI:1508371790
Name:WYATT, NICOLE BRITTNEY (APRN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:BRITTNEY
Last Name:WYATT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2885 SW 3RD AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33129-2324
Mailing Address - Country:US
Mailing Address - Phone:305-590-5300
Mailing Address - Fax:
Practice Address - Street 1:15036 SW 67TH LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-2005
Practice Address - Country:US
Practice Address - Phone:786-399-3659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-10
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9366877163WC0200X, 363LA2100X
FLARNP9366877363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000OtherNOT APPLICABLE