Individual
ALLISON NICOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1239 E MAIN ST, BARTOW, FL 33830-5058
(863) 519-0575
(863) 582-9251
Mailing address
PO BOX 1559, BARTOW, FL 33831-1559
(863) 519-0575
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
SW13296
FL
225400000X
Rehabilitation Practitioner
# 95-1647832
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016379400
—
FL
Enumeration date
08/02/2011
Last updated
01/19/2016
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