MEDICARE: GEORGINA NICHOLS M.D.

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	208200000X	Plastic Surgery Physician	175636	CA
2	208200000X	Plastic Surgery Physician	ME151972	FL

General Provider Information

NPI Number	:	1558781179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGINA NICHOLS M.D.

Provider Business Mailing Address
First Line	:	915 MIDDLE RIVER DR STE 213
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-3560
Country	:	US
Telephone Number	:	561-529-5077
Fax Number	:	887-561-5267

Provider Business Practice Location Address
First Line	:	915 MIDDLE RIVER DR STE 213
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-3560
Country	:	US
Telephone Number	:	561-529-5570
Fax Number	:	877-561-5267

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

Provider Enumeration Date	:	04/22/2014
Last Update Date	:	06/04/2026

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