Provider Demographics
NPI:1659680007
Name:MASSE, NICOLA ANNE (MD)
Entity Type:Individual
Prefix:
First Name:NICOLA
Middle Name:ANNE
Last Name:MASSE
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 1:5310 NW 33RD AVE
Mailing Address - Street 2:SUITE 216
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-6376
Mailing Address - Country:US
Mailing Address - Phone:954-731-9676
Mailing Address - Fax:954-731-9747
Practice Address - Street 1:12957 PALMS WEST DR
Practice Address - Street 2:BLDG. 9, SUITE 202
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-4932
Practice Address - Country:US
Practice Address - Phone:561-795-5979
Practice Address - Fax:561-795-9460
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83290208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263118100Medicaid