Active NPI
Nicole Ingicco
- Registered Dietitian
- Sunrise, FL
National Provider Identifier
1043002983
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 12037
- Practice address
- 5405 NW 102ND Ave
Sunrise, FL 33351-8746 - Phone
- (954) 918-1214
- NPI assigned
- May 19, 2025
- Last updated
- Sep 9, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 12037 | FL | Primary |
Addresses
Primary practice location
5405 NW 102ND Ave
Sunrise, FL 33351-8746
Mailing address
2521 NW 112TH Ave
Coral Springs, FL 33065-3537
Phone (954) 918-1214
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12037 | FL | MD | Periodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1747612800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757376000000",
"number": "1043002983",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2521 NW 112TH AVE",
"city": "CORAL SPRINGS",
"state": "FL",
"postal_code": "330653537",
"telephone_number": "954-918-1214"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5405 NW 102ND AVE",
"city": "SUNRISE",
"state": "FL",
"postal_code": "333518746",
"telephone_number": "954-918-1214"
}
],
"practiceLocations": [],
"basic": {
"last_name": "INGICCO",
"first_name": "NICOLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-05-19",
"last_updated": "2025-09-09",
"certification_date": "2025-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "FL",
"license": "12037",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sunrise, FL
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- Ingrid Whitbourne-Cooke, O.D.,P.a.
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.