Provider Demographics
NPI:1487919668
Name:NICOLO, DEBORAH TERESA (RN)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:TERESA
Last Name:NICOLO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:GLAM SQUAD,LLC
Other - Middle Name:DBA
Other - Last Name:NURSE ON CALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:12120 ROSELAND DR
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34654-6316
Mailing Address - Country:US
Mailing Address - Phone:727-226-7844
Mailing Address - Fax:
Practice Address - Street 1:12120 ROSELAND DR
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34654-6316
Practice Address - Country:US
Practice Address - Phone:727-226-7844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9533054163W00000X
TX304690164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017504100Medicaid
FL81-4658807OtherGLAM SQUAD,LLC/DBA NURSE ON CALL