Provider Demographics
NPI:1053806117
Name:PINELO NICHOLSON, NOELI (MD)
Entity type:Individual
Prefix:
First Name:NOELI
Middle Name:
Last Name:PINELO NICHOLSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 VETERANS PARK DR STE 201
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-0446
Mailing Address - Country:US
Mailing Address - Phone:239-260-1033
Mailing Address - Fax:239-260-1491
Practice Address - Street 1:1855 VETERANS PARK DR STE 201
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-0446
Practice Address - Country:US
Practice Address - Phone:239-260-1033
Practice Address - Fax:239-260-1491
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME156268207Q00000X
PR22327207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine