Provider Demographics
NPI:1861043861
Name:FRYE, NICOLE E S
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:E S
Last Name:FRYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 N OCEAN BLVD APT 1709
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-5150
Mailing Address - Country:US
Mailing Address - Phone:614-517-6188
Mailing Address - Fax:
Practice Address - Street 1:405 N OCEAN BLVD APT 1709
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-5150
Practice Address - Country:US
Practice Address - Phone:614-517-6188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider