Healthcare Provider Details

I. General information

NPI: 1346403052
Provider Name (Legal Business Name): NICHOLAS C JAMES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 SE WILLOUGHBY BLVD
STUART FL
34994-5059
US

IV. Provider business mailing address

3515 SE WILLOUGHBY BLVD
STUART FL
34994-5059
US

V. Phone/Fax

Practice location:
  • Phone: 772-210-2037
  • Fax: 772-362-4278
Mailing address:
  • Phone: 772-210-2037
  • Fax: 772-362-4278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberOS15500
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberOS15500
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: