Provider Demographics
NPI:1174148613
Name:GORTAIRE, NICOLE C (DPM)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:C
Last Name:GORTAIRE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 US HIGHWAY 1 S STE C
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-6024
Mailing Address - Country:US
Mailing Address - Phone:904-436-8001
Mailing Address - Fax:904-376-7761
Practice Address - Street 1:1690 US HIGHWAY 1 S STE C
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-6024
Practice Address - Country:US
Practice Address - Phone:904-436-8001
Practice Address - Fax:904-376-7761
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO4445213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery