Individual
NICOLE KALLSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3501 JOHNSON ST, HOLLYWOOD, FL 33021-5421
(954) 265-5970
Mailing address
1117 E HALLANDALE BEACH BLVD, HALLANDALE BEACH, FL 33009-4488
Taxonomy
Speciality
Code
Description
License number
State
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
ARNP934484
FL
363LF0000X
Family Nurse Practitioner
ARNP934484
FL
Other
Enumeration date
08/15/2017
Last updated
03/23/2021
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