Summer Nicole Niles

Primary specialty

DentistTaxonomy code 122300000X

License

DN 22179 Issued in FL

Practice address

1679 NW Saint Lucie West Blvd
Port Saint Lucie, FL 34986-2106

Phone

(772) 261-0027

NPI assigned

Jul 20, 2016

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

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1468972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470182400000",
    "number": "1669825113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1679 NW SAINT LUCIE WEST BLVD",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349862106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1679 NW SAINT LUCIE WEST BLVD",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349862106",
            "telephone_number": "772-261-0027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NILES",
        "first_name": "SUMMER",
        "middle_name": "NICOLE",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-07-20",
        "last_updated": "2016-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN 22179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Sconzo Enterprises LLC
• Nicole Vendette, LLC
• Anthony Peter Nicosia, M.D.
• Breana Nicotra, MS
• Rozeta Nikolova
• Jasmine Noel
• Kettia Noel
• Michael Noelus
• Alba Nolasco
• Muhammad Syed Nooruddin, PT

• Dentist in Port Saint Lucie, FL
• Providers in Port Saint Lucie, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.