Provider Demographics
NPI:1538726922
Name:ELLIOTT, NICKOLA (LIFE COACH)
Entity type:Individual
Prefix:DR
First Name:NICKOLA
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LIFE COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 CATALINA AVE NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-1835
Mailing Address - Country:US
Mailing Address - Phone:407-602-5252
Mailing Address - Fax:
Practice Address - Street 1:1563 GEORGIA ST NE STE 3
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-2565
Practice Address - Country:US
Practice Address - Phone:407-602-5252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor