MEDICARE: MRS. MARNI L NICHOLAS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	12286	NH
2	207R00000X	Internal Medicine Physician	229705	NY
3	207R00000X	Internal Medicine Physician	ME123735	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174517122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARNI L NICHOLAS MD

Provider Business Mailing Address
First Line	:	1080 E INDIANTOWN RD
Second Line	:	SUITE 206
City	:	JUPITER
State	:	FL
Zip	:	33477-5100
Country	:	US
Telephone Number	:	561-741-5566
Fax Number	:	561-295-5237

Provider Business Practice Location Address
First Line	:	1080 E INDIANTOWN RD
Second Line	:	SUITE 206
City	:	JUPITER
State	:	FL
Zip	:	33477-5100
Country	:	US
Telephone Number	:	561-741-5566
Fax Number	:	561-295-5237

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	01/29/2016

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