Provider Demographics
NPI:1548555790
Name:NIKIEL DUL, JOLANTA (LMT)
Entity Type:Individual
Prefix:
First Name:JOLANTA
Middle Name:
Last Name:NIKIEL DUL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 TAMIAMI TRL S
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2420
Mailing Address - Country:US
Mailing Address - Phone:941-223-4732
Mailing Address - Fax:941-485-8053
Practice Address - Street 1:245 TAMIAMI TRL S
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2420
Practice Address - Country:US
Practice Address - Phone:941-223-4732
Practice Address - Fax:941-485-8053
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA40292225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist