Provider Demographics
NPI:1609038702
Name:FIGUEREDO, NICOLE D (MD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:D
Last Name:FIGUEREDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6919 N DALE MABRY HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3972
Mailing Address - Country:US
Mailing Address - Phone:813-933-3324
Mailing Address - Fax:813-932-4357
Practice Address - Street 1:6919 N DALE MABRY HWY STE 200
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3972
Practice Address - Country:US
Practice Address - Phone:813-933-3324
Practice Address - Fax:813-932-4357
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08657300208600000X
FLME131521208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0217450Medicaid
NJ167347R63Medicare PIN
NJ0217450Medicaid