Provider Demographics
NPI:1306583307
Name:SILVA, NICOLE ROTCEH (RBT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ROTCEH
Last Name:SILVA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25924 SW 139TH PATH
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6697
Mailing Address - Country:US
Mailing Address - Phone:786-448-8207
Mailing Address - Fax:
Practice Address - Street 1:25924 SW 139TH PATH
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-6697
Practice Address - Country:US
Practice Address - Phone:786-448-8207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician