Provider Demographics
NPI:1538748876
Name:MCCLOSKEY, NICOLE TERESA (APRN)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:TERESA
Last Name:MCCLOSKEY
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5526 SUPERIOR DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-8001
Mailing Address - Country:US
Mailing Address - Phone:321-235-0692
Mailing Address - Fax:321-235-0694
Practice Address - Street 1:5526 SUPERIOR DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-8001
Practice Address - Country:US
Practice Address - Phone:813-263-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9477203163WP0808X
FLAPRN11018077363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health