Provider Demographics
NPI:1770907313
Name:CUMBERBATCH, NICHA MONIQUE (PA-C)
Entity type:Individual
Prefix:
First Name:NICHA
Middle Name:MONIQUE
Last Name:CUMBERBATCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NICHA
Other - Middle Name:
Other - Last Name:CUMBERBATCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10157 RAMBLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-6509
Mailing Address - Country:US
Mailing Address - Phone:954-560-7711
Mailing Address - Fax:
Practice Address - Street 1:7710 NW 71ST CT STE 205
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2931
Practice Address - Country:US
Practice Address - Phone:954-747-1221
Practice Address - Fax:954-747-1231
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108593363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant