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General NPI Number Information
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NPI Number | 1447600077
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Entity Type | Individual
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Provider Name | NICHOLAS GRAY
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Gender | Male
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Dates
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Enumeration Date | 06/14/2016
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Last Update Date | 10/23/2020
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Provider Practice Location Address
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Address Line | 1665 KINGSLEY AVE SUITE 108
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City | ORANGE PARK
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State | FL
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Zip | 32073-4490
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Country | US
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Telephone | 904-579-3704
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Fax |
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Provider Business Mailing Address
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Address Line | 1513 CHATHAM CT
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-5050
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | AS5149
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License Number State | FL
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