Provider Demographics
NPI:1700994795
Name:TODAR, NICOLE M (DO)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:TODAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 850001 DEPT 991
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32885-0991
Mailing Address - Country:US
Mailing Address - Phone:800-248-1639
Mailing Address - Fax:
Practice Address - Street 1:995 MAR WALT DR
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6758
Practice Address - Country:US
Practice Address - Phone:850-863-7887
Practice Address - Fax:850-863-0863
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7509207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2683863100Medicaid
FL2683863100Medicaid
F85054Medicare UPIN