MEDICARE: NICHOLAS ANTHONY COLALUCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	ME179315	FL

General Provider Information

NPI Number	:	1417606187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS ANTHONY COLALUCA

Provider Business Mailing Address
First Line	:	653 W 8TH ST # L18
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-6511
Country	:	US
Telephone Number	:	904-244-3094
Fax Number	:	904-244-7388

Provider Business Practice Location Address
First Line	:	653-1 WEST 8TH STREET
Second Line	:	L20 4TH FLOOR, LRC
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209
Country	:	US
Telephone Number	:	904-244-8846
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2022
Last Update Date	:	03/13/2026

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