Provider Demographics
NPI:1639898000
Name:KIRBY, NICOLE ALEXIS (RCCS, RCS, RPHS, RVS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ALEXIS
Last Name:KIRBY
Suffix:
Gender:F
Credentials:RCCS, RCS, RPHS, RVS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3962 DERBY GLEN DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-4608
Mailing Address - Country:US
Mailing Address - Phone:813-789-5975
Mailing Address - Fax:
Practice Address - Street 1:3962 DERBY GLEN DR
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-4608
Practice Address - Country:US
Practice Address - Phone:813-789-5975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL000694222085U0001X
000694222471S1302X, 2471V0105X, 2471C1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C1101XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistCardiovascular-Interventional Technology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography