Provider Demographics
NPI:1194726430
Name:PEARSON, NICOLE ANTOINETTE (MD)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:ANTOINETTE
Last Name:PEARSON
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 1:1920 PALM BEACH LAKES BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-3506
Mailing Address - Country:US
Mailing Address - Phone:561-509-5009
Mailing Address - Fax:561-738-1822
Practice Address - Street 1:5589 OKEECHOBEE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-4486
Practice Address - Country:US
Practice Address - Phone:561-509-5009
Practice Address - Fax:561-798-2733
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 84271208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0273574100Medicaid
FL16839OtherBCBS OF FL