Provider Demographics
NPI:1720606650
Name:DI NICOLA, MAURA (MD)
Entity Type:Individual
Prefix:
First Name:MAURA
Middle Name:
Last Name:DI NICOLA
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 1:900 NW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1134
Mailing Address - Country:US
Mailing Address - Phone:305-482-7050
Mailing Address - Fax:305-326-6417
Practice Address - Street 1:900 NW 17TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1134
Practice Address - Country:US
Practice Address - Phone:305-482-7050
Practice Address - Fax:305-326-6417
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME160193207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology