Provider Demographics
NPI:1245035617
Name:RENDOS SPEER, NICOLE KRISTEN (PHD, LAT, ATC, CSCS)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:KRISTEN
Last Name:RENDOS SPEER
Suffix:
Gender:
Credentials:PHD, LAT, ATC, CSCS
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:KRISTEN
Other - Last Name:RENDOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LAT, ATC, CSCS
Mailing Address - Street 1:2400 CONNELL DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-4262
Mailing Address - Country:US
Mailing Address - Phone:845-729-5797
Mailing Address - Fax:
Practice Address - Street 1:41 S ALCANIZ ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-6007
Practice Address - Country:US
Practice Address - Phone:850-202-4462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL31742255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer