Provider Demographics
NPI:1578283867
Name:MARCUS, NICOLE ELDRIDGE (PHD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ELDRIDGE
Last Name:MARCUS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7685 SW 104TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-3161
Mailing Address - Country:US
Mailing Address - Phone:305-877-3333
Mailing Address - Fax:
Practice Address - Street 1:7685 SW 104TH ST STE 100
Practice Address - Street 2:
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-3161
Practice Address - Country:US
Practice Address - Phone:305-877-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7161103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1669517462OtherNPPES