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Individual
NICOLE DUMAS VANDERLAAN
Active
Individual
NICOLE DUMAS VANDERLAAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
5601002686
MI
363A00000X
Physician Assistant
Primary
PA9105000
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105849200
—
FL
01
—
12716853
CAQH
—
01
—
ED025Z
PTAN
—
Enumeration date
02/17/2006
Last updated
04/16/2025
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