Provider Demographics
NPI:1245888080
Name:MUNOZ, NICOLE ANGELIQUE (APRN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANGELIQUE
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17413 SW 19TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5535
Mailing Address - Country:US
Mailing Address - Phone:954-258-5799
Mailing Address - Fax:
Practice Address - Street 1:17413 SW 19TH ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-5535
Practice Address - Country:US
Practice Address - Phone:954-258-5799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11003718363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner