Healthcare Provider Details

I. General information

NPI: 1033006010
Provider Name (Legal Business Name): NICHOLAS DANIEL MADSEN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2025
Last Update Date: 06/21/2025
Certification Date: 06/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 CENTRE POINTE BLVD
TALLAHASSEE FL
32308-4894
US

IV. Provider business mailing address

6616 KINGMAN TRL
TALLAHASSEE FL
32309-1720
US

V. Phone/Fax

Practice location:
  • Phone: 850-339-4588
  • Fax:
Mailing address:
  • Phone: 850-339-4588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN9423776
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: