Provider Demographics
NPI:1538451703
Name:SCHULTZ, NICOLE (ARNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:RITSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN
Mailing Address - Street 1:6767 N WICKHAM RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-2031
Mailing Address - Country:US
Mailing Address - Phone:321-751-1925
Mailing Address - Fax:
Practice Address - Street 1:6767 N WICKHAM RD
Practice Address - Street 2:SUITE 306
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2031
Practice Address - Country:US
Practice Address - Phone:321-751-1925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-06
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA621101163W00000X
PASP011422363LP0808X
FLARNP9298519363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse