Healthcare Provider Details

I. General information

NPI: 1578191326
Provider Name (Legal Business Name): NICHOLAS ANTHONY MCDONALD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2020
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 7TH ST N
NAPLES FL
34102-5754
US

IV. Provider business mailing address

911 BYPASS RD
PIKEVILLE KY
41501-1602
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-0940
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number2004-00948
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: