Provider Demographics
NPI:1780046391
Name:DEMAS, NICOLE (ARNP-C)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:DEMAS
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:RENAUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1323 W FLETCHER AVE STE A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-3310
Mailing Address - Country:US
Mailing Address - Phone:813-968-4293
Mailing Address - Fax:
Practice Address - Street 1:1323 W FLETCHER AVE STE A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-3310
Practice Address - Country:US
Practice Address - Phone:813-968-4293
Practice Address - Fax:813-968-3182
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9338128363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily