MEDICARE: NICHOLAS ACKRON

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	106S00000X	Behavior Technician
2	247200000X	Other Technician

General Provider Information

NPI Number	:	1861203317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS ACKRON

Provider Business Mailing Address
First Line	:	17 PRINCE WALTER LN
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-7151
Country	:	US
Telephone Number	:	772-494-8337
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 PRINCE WALTER LN
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-7151
Country	:	US
Telephone Number	:	772-494-8337
Fax Number	:

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

Provider Enumeration Date	:	01/15/2025
Last Update Date	:	01/15/2025

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Directions to “ NICHOLAS ACKRON ” Practice Location

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