Provider Demographics
NPI:1316172083
Name:CALDWELL, NICOLE TIQUANA (CNA/PCT/MHT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:TIQUANA
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:CNA/PCT/MHT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:TIQUANA
Other - Last Name:DAWKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 100736
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33310-0736
Mailing Address - Country:US
Mailing Address - Phone:954-708-4646
Mailing Address - Fax:754-206-2147
Practice Address - Street 1:1200 NW 5TH AVE # 1
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-6027
Practice Address - Country:US
Practice Address - Phone:954-708-4646
Practice Address - Fax:754-206-2147
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLC.N.A 127560376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No376K00000XNursing Service Related ProvidersNurse's Aide