Provider Demographics
NPI:1710216379
Name:EGGEBRECHT, NICOLE AMBER (ARNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:AMBER
Last Name:EGGEBRECHT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 863407
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-3407
Mailing Address - Country:US
Mailing Address - Phone:941-917-2600
Mailing Address - Fax:941-917-7884
Practice Address - Street 1:929 S TAMIAMI TRL
Practice Address - Street 2:SUITE 101
Practice Address - City:OSPREY
Practice Address - State:FL
Practice Address - Zip Code:34229-9239
Practice Address - Country:US
Practice Address - Phone:941-917-4700
Practice Address - Fax:941-917-4710
Is Sole Proprietor?:No
Enumeration Date:2009-12-10
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9202157363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY02AFOtherBCBS
FL001746500Medicaid
FLY02AFOtherBCBS