Provider Demographics
NPI:1295560795
Name:BAPTISTA, NICOL ANDREYS SR
Entity type:Individual
Prefix:
First Name:NICOL
Middle Name:ANDREYS
Last Name:BAPTISTA
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 W FLAGLER ST APT 11
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2359
Mailing Address - Country:US
Mailing Address - Phone:786-589-1033
Mailing Address - Fax:
Practice Address - Street 1:9000 W FLAGLER ST APT 11
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2359
Practice Address - Country:US
Practice Address - Phone:786-589-1033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-357896106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician