Provider Demographics
NPI:1912460924
Name:MABARDI, NICOLE (APRN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:MABARDI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 SW 27TH AVE APT 505
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-3001
Mailing Address - Country:US
Mailing Address - Phone:305-484-9426
Mailing Address - Fax:
Practice Address - Street 1:3901 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5504
Practice Address - Country:US
Practice Address - Phone:305-854-1133
Practice Address - Fax:305-514-0076
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010983363LF0000X
FLAPRN9396730363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily