Provider Demographics
NPI:1982029864
Name:MADALON, NICOLE A (ARNP-CNM)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:A
Last Name:MADALON
Suffix:
Gender:F
Credentials:ARNP-CNM
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Mailing Address - Street 1:38135 MARKET SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7505
Mailing Address - Country:US
Mailing Address - Phone:352-567-0188
Mailing Address - Fax:813-355-5100
Practice Address - Street 1:14014 N 46TH ST STE C
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4238
Practice Address - Country:US
Practice Address - Phone:813-284-2229
Practice Address - Fax:813-377-1681
Is Sole Proprietor?:No
Enumeration Date:2014-02-28
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2014002554367A00000X
GARN274702367A00000X
IL209011060367A00000X
FLARNP9437823367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018447200Medicaid
FLIR190ZMedicare PIN