Provider Demographics
NPI:1659361988
Name:COWETTE, NICOLE A (C-PA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:A
Last Name:COWETTE
Suffix:
Gender:F
Credentials:C-PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 37TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4863
Mailing Address - Country:US
Mailing Address - Phone:772-766-0789
Mailing Address - Fax:772-581-3991
Practice Address - Street 1:1600 37TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4863
Practice Address - Country:US
Practice Address - Phone:772-766-0789
Practice Address - Fax:772-581-3991
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102638363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU2463VOtherMEDICARE P-TAN
FLU2463VOtherMEDICARE P-TAN