Individual
NICOLE A DEVLIEGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4539 S DALE MABRY HWY STE 110, TAMPA, FL 33611
(813) 250-1208
Mailing address
11526 LEDA LN, NEW PORT RICHEY, FL 34654-6237
(727) 265-0995
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AL4899
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7272650995
PHONE
—
Enumeration date
01/03/2017
Last updated
08/01/2019
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