Individual provider Active NPI

Nicole R Robichaux, ARNP, PSYD

  • Psychiatric/Mental Health Nurse Practitioner
  • Safety Harbor, FL
National Provider Identifier
1871600775
Registry record updated Sep 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
ARNP9351504 Issued in FL
Practice address
100 Main St
Suite 203
Safety Harbor, FL 34695
Phone
(727) 799-4150
Fax
(727) 796-1845
NPI assigned
Aug 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PY9448 FL
Psychiatric/Mental Health Nurse Practitioner 363LP0808X ARNP9351504 FL Primary

Addresses

Primary practice location

100 Main St
Suite 203
Safety Harbor, FL 34695

Mailing address

100 Main St
Suite 203
Safety Harbor, FL 34695-3657
Phone (727) 799-4150

Other identifiers 1

IdentifierTypeStateIssuer
22849700MedicaidFL

Other names 1

  • Nicole R Keene Former name

Medicare participation

Medicare enrollment files
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: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041230000326 FL Practitioner - Nurse Practitioner 6800854308 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Tampa NeuropsychiatryGroup PAC ID 4385928647, 15 clinicians

Practice addresses (Care Compare)

33920 US Hwy 19 N
Suite 340
Palm Harbor, FL 34684-2670
Phone (813) 995-1775

4710 N Habana Ave
Suite 203
Tampa, FL 33614-7146
Phone (813) 995-1775

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
PY9448FLMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Behavioral Healthcare Options, Inc. CurrentSince Jun 25, 2013 Accepting new patients
Ibis Healthcare Inc CurrentSince Nov 17, 2019 Accepting new patients
Ibis Healthcare Inc CurrentSince Nov 17, 2019 Accepting new patients
Kolettis Krew LLC PastSince Jun 25, 2013 Accepting new patients

Locations

11300 US Highway 19 N
Clearwater, FL 33764
Phone (727) 541-2646

100 Main St
Ste 203
Safety Harbor, FL 34695
Phone (727) 738-8410

5707 N 22nd St
Tampa, FL 33610
Phone (813) 272-2244

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600300800000",
    "number": "1871600775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MAIN ST",
            "address_2": "SUITE 203",
            "city": "SAFETY HARBOR",
            "state": "FL",
            "postal_code": "346953657",
            "telephone_number": "727-799-4150",
            "fax_number": "727-796-1845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MAIN ST",
            "address_2": "SUITE 203",
            "city": "SAFETY HARBOR",
            "state": "FL",
            "postal_code": "34695",
            "telephone_number": "727-799-4150",
            "fax_number": "727-796-1845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBICHAUX",
        "first_name": "NICOLE",
        "middle_name": "R",
        "credential": "ARNP, PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-24",
        "last_updated": "2020-09-17",
        "certification_date": "2020-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY9448",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "ARNP9351504",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "22849700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "KEENE",
            "middle_name": "R",
            "credential": "ARNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Safety Harbor, FL

Sources for this page

Verify at the official NPI Registry.