MEDICARE: DR. PATRICIA NICHOLAS D.P.M.

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	213E00000X	Podiatrist	PO3946	FL

General Provider Information

NPI Number	:	1174587075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA NICHOLAS D.P.M.

Provider Business Mailing Address
First Line	:	12670 CREEKSIDE LN STE 202
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3370
Country	:	US
Telephone Number	:	239-482-2663
Fax Number	:	239-485-7585

Provider Business Practice Location Address
First Line	:	12670 CREEKSIDE LN STE 202
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3370
Country	:	US
Telephone Number	:	239-482-2663
Fax Number	:	239-482-7585

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

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	10/04/2024

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