Provider Demographics
NPI:1023429016
Name:HUBER, NICOLE MARIE (OPA-C, CSFA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:HUBER
Suffix:
Gender:F
Credentials:OPA-C, CSFA
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:HUBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12600 AVERY RANCH BLVD
Mailing Address - Street 2:APT 215
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-1690
Mailing Address - Country:US
Mailing Address - Phone:850-776-0325
Mailing Address - Fax:
Practice Address - Street 1:12600 AVERY RANCH BLVD
Practice Address - Street 2:APT. 215
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-1690
Practice Address - Country:US
Practice Address - Phone:850-776-0325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2015-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant