MEDICARE: MR. DELON NICHOLAS PA

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	363A00000X	Physician Assistant	PA 3740	FL

General Provider Information

NPI Number	:	1487625992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DELON NICHOLAS PA

Provider Business Mailing Address
First Line	:	8029 MOSSY CREEK RD
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32526
Country	:	US
Telephone Number	:	850-944-4718
Fax Number	:	850-492-4877

Provider Business Practice Location Address
First Line	:	8029 MOSSY CRK
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32526-8420
Country	:	US
Telephone Number	:	850-944-4718
Fax Number	:	850-492-4877

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

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	07/08/2007

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