Provider Demographics
NPI:1568776813
Name:GOTTLIEB, NICOLE L (APRN-C)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:L
Last Name:GOTTLIEB
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 SUNSET DR
Mailing Address - Street 2:#402
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4828
Mailing Address - Country:US
Mailing Address - Phone:305-662-8730
Mailing Address - Fax:305-662-8736
Practice Address - Street 1:6200 SUNSET DR
Practice Address - Street 2:#402
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4828
Practice Address - Country:US
Practice Address - Phone:305-662-8730
Practice Address - Fax:305-662-8736
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP-9186336363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily