Provider Demographics
NPI:1780902494
Name:CACHO, NICOLE THERESA (DO)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:THERESA
Last Name:CACHO
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:UF DIVISION OF NEONATOLOGY
Mailing Address - Street 2:P.O. BOX 100296
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0296
Mailing Address - Country:US
Mailing Address - Phone:352-273-8985
Mailing Address - Fax:352-273-9054
Practice Address - Street 1:1600 SW ARCHER ROAD
Practice Address - Street 2:SHANDS HOSPITAL
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607
Practice Address - Country:US
Practice Address - Phone:352-273-8985
Practice Address - Fax:352-273-9054
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO2347208000000X
FLOS122312080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017856600Medicaid
FL017856600Medicaid