Provider Demographics
NPI:1790041200
Name:RICH, NICOLE (RPSGT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:RICH
Suffix:
Gender:F
Credentials:RPSGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E KING ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1205
Mailing Address - Country:US
Mailing Address - Phone:407-303-1558
Mailing Address - Fax:407-303-1567
Practice Address - Street 1:501 E KING ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1205
Practice Address - Country:US
Practice Address - Phone:407-303-1558
Practice Address - Fax:407-303-1567
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12715246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other