Provider Demographics
NPI:1790227494
Name:SHAFAR, NICOLE A (ARNP)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:A
Last Name:SHAFAR
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:A
Other - Last Name:SHAFAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:305-500-2000
Mailing Address - Fax:
Practice Address - Street 1:7649 W COLONIAL DR STE 115
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-7423
Practice Address - Country:US
Practice Address - Phone:407-522-2080
Practice Address - Fax:833-963-0115
Is Sole Proprietor?:No
Enumeration Date:2016-11-11
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9309557363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLKT224OtherMEDICARE
FL022712300Medicaid