Healthcare Provider Details

I. General information

NPI: 1821099615
Provider Name (Legal Business Name): CHRIST JOHN TICORAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9125 CORSEA DEL FONTANA WAY STE 100
NAPLES FL
34109-4430
US

IV. Provider business mailing address

900 VILLAGE SQUARE XING STE 290
PALM BEACH GARDENS FL
33410-4552
US

V. Phone/Fax

Practice location:
  • Phone: 239-598-4004
  • Fax: 239-598-4713
Mailing address:
  • Phone: 239-434-0303
  • Fax: 239-262-8730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME172595
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: