Provider Demographics
NPI:1861755845
Name:NICOLETTE, TRICIA LYNNE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:LYNNE
Last Name:NICOLETTE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14421 METROPOLIS AVE
Mailing Address - Street 2:UNIT 103
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4323
Mailing Address - Country:US
Mailing Address - Phone:239-561-2778
Mailing Address - Fax:
Practice Address - Street 1:14421 METROPOLIS AVE
Practice Address - Street 2:UNIT 103
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4323
Practice Address - Country:US
Practice Address - Phone:239-561-2778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-24
Last Update Date:2014-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ5721235Z00000X
FLSA 12070235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist