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General NPI Number Information
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NPI Number | 1467718767
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Entity Type | Individual
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Provider Name | PATRICIA P NICHOLSON NP
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Gender | Female
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Dates
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Enumeration Date | 04/11/2012
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 5610 WENDY BAGWELL PKWY
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City | HIRAM
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State | GA
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Zip | 30141-7837
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Country | US
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Telephone | 770-943-7808
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Fax |
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Provider Business Mailing Address
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Address Line | 601 S HARBOUR ISLAND BLVD STE 200
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City | TAMPA
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State | FL
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Zip | 33602-5925
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Country | US
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Telephone | 813-444-5838
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN194493
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License Number State | GA
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