Provider Demographics
NPI:1821026956
Name:URRUTIA, NICOLE MARIA (DPM)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MARIA
Last Name:URRUTIA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 VALENCIA CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1214
Mailing Address - Country:US
Mailing Address - Phone:813-928-2993
Mailing Address - Fax:
Practice Address - Street 1:288 VALENCIA CIR
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-1214
Practice Address - Country:US
Practice Address - Phone:813-928-2993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2020-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2516213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU63555Medicare UPIN