Provider Demographics
NPI:1831169804
Name:BASILE, NICOLE ANN (MD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANN
Last Name:BASILE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 N DIXIE HWY STE 304
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2717
Mailing Address - Country:US
Mailing Address - Phone:561-475-5700
Mailing Address - Fax:
Practice Address - Street 1:1500 N DIXIE HWY STE 304
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2717
Practice Address - Country:US
Practice Address - Phone:561-475-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89474207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I03498Medicare UPIN
FL46029Medicare ID - Type Unspecified