Provider Demographics
NPI:1770226359
Name:MARTITSCH-KREINER, NICOLE (RN/ARNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:MARTITSCH-KREINER
Suffix:
Gender:F
Credentials:RN/ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 NW 64TH ST
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1614
Mailing Address - Country:US
Mailing Address - Phone:802-236-7067
Mailing Address - Fax:
Practice Address - Street 1:1905 CLINT MOORE RD STE 101
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-2696
Practice Address - Country:US
Practice Address - Phone:561-912-9191
Practice Address - Fax:561-372-0989
Is Sole Proprietor?:No
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9295689163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical