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General NPI Number Information
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NPI Number | 1518002278
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Entity Type | Individual
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Provider Name | IRENE ANDREA NICKOLAKIS M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1501 S PINELLAS AVE SUITE K
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City | TARPON SPRINGS
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State | FL
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Zip | 34689-1955
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Country | US
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Telephone | 727-938-0714
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Fax | 727-938-9513
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Provider Business Mailing Address
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Address Line | 1501 S PINELLAS AVE SUITE K
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City | TARPON SPRINGS
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State | FL
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Zip | 34689-1955
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Country | US
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Telephone | 727-938-0714
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Fax | 727-938-9513
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME0055877
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License Number State | FL
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