Healthcare Provider Details

I. General information

NPI: 1932370681
Provider Name (Legal Business Name): CAMERON LEE NICHOLSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2008
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9981 S HEALTHPARK DR STE 156
FORT MYERS FL
33908-3618
US

IV. Provider business mailing address

P.O. BOX 2147
FT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-5333
  • Fax: 239-343-5321
Mailing address:
  • Phone: 239-343-5553
  • Fax: 239-343-5321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME102793
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57.006511
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberME102793
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: