Healthcare Provider Details

I. General information

NPI: 1962231142
Provider Name (Legal Business Name): SOMETHINGS MEDICAL PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85561 WILSON NECK RD
YULEE FL
32097-4782
US

IV. Provider business mailing address

447 BROADWAY FL 2
NEW YORK NY
10013-2562
US

V. Phone/Fax

Practice location:
  • Phone: 345-601-5896
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS NISSEN
Title or Position: PRESIDENT
Credential: MD
Phone: 949-463-0650