Provider Demographics
NPI:1013794536
Name:NOCTURNIST HEALTH, LLC
Entity Type:Organization
Organization Name:NOCTURNIST HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:TAKESHANICOLE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:ZIEMBLICKI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:417-619-0660
Mailing Address - Street 1:10627 DAWNS LIGHT DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-6107
Mailing Address - Country:US
Mailing Address - Phone:417-619-0660
Mailing Address - Fax:813-430-0942
Practice Address - Street 1:7777 131ST ST STE 14
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33776-4015
Practice Address - Country:US
Practice Address - Phone:813-680-1600
Practice Address - Fax:813-430-0942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care