Provider Demographics
NPI:1730838921
Name:WENNINGHOFF, NICOLE LEA (RRT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LEA
Last Name:WENNINGHOFF
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4323 CRESTFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34691-1604
Mailing Address - Country:US
Mailing Address - Phone:727-483-0986
Mailing Address - Fax:
Practice Address - Street 1:4323 CRESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-1604
Practice Address - Country:US
Practice Address - Phone:727-483-0986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRRT11273227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered