Provider Demographics
NPI:1043009251
Name:EHRHARDT, NICOLE MARIE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:EHRHARDT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 SAND DUNE DR
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA
Mailing Address - State:FL
Mailing Address - Zip Code:32169-4309
Mailing Address - Country:US
Mailing Address - Phone:720-393-0404
Mailing Address - Fax:
Practice Address - Street 1:13 SAND DUNE DR
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA
Practice Address - State:FL
Practice Address - Zip Code:32169-4309
Practice Address - Country:US
Practice Address - Phone:720-393-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered