Nicole Phillips, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

12044065 Issued in FL

Practice address

8053 West Oakland Park Blvd
Suite 950
Sunrise, FL 33351-7776

Phone

(754) 422-2165

NPI assigned

Jan 30, 2018

Reactivated

Sep 9, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fundamental ABA Therapy,LLC

  • Behavior Analyst
  • Sunrise, FL
  • NPI 1609463298
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1517270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669593600000",
    "number": "1508364019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8053 W OAKLAND PARK BLVD STE 950",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333511162",
            "telephone_number": "754-422-2165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8053 WEST OAKLAND PARK BLVD",
            "address_2": "SUITE 950",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333517776",
            "telephone_number": "754-422-2165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "NICOLE",
        "credential": "BCBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-01-30",
        "last_updated": "2022-11-28",
        "certification_date": "2021-02-20",
        "deactivation_date": "2018-01-30",
        "reactivation_date": "2020-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "FL",
            "license": "12044065",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rose Linda Philip-Olivert
• Chimika Y Philippe
• Jasmin Philippe
• Phillip P Gager D C P a
• Maureen Phillips
• Fabia S Philogene
• Phoenix Emergency Medicine of Broward LLC
• Physician Choice Pharmacy LLC
• Physicians Care Plus Inc
• Physicians Health Care Systems LLC

• Behavior Analyst in Sunrise, FL
• Providers in Sunrise, FL by specialty
• Behavior Analyst in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.