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NPI Code Detail

MEDICARE: DR. SANDRA W NICHOLS PHD, APRN, PMHNP-BC,

MEDICARE: DR. SANDRA W NICHOLS PHD, APRN, PMHNP-BC,
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner0024171054VA
2363LP0808XPsychiatric/Mental Health Nurse Practitioner5012159NC
3363LF0000XFamily Nurse Practitioner0024171054VA
4363LP0808XPsychiatric/Mental Health Nurse PractitionerAP10570AZ
5363LF0000XFamily Nurse PractitionerARNP9241995FL
6363LP0808XPsychiatric/Mental Health Nurse Practitioner9241995FL
7363LF0000XFamily Nurse Practitioner184239GA
8363LP0808XPsychiatric/Mental Health Nurse Practitioner184239GA
9363L00000XNurse PractitionerAP10570AZ
10363L00000XNurse PractitionerA004963AR
11363L00000XNurse Practitioner21255TN

General Provider Information

NPI Number : 1770749202
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SANDRA W NICHOLS PHD, APRN, PMHNP-BC,
Provider Business Mailing Address
First Line : 4360 SHORE DR STE 101
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23455-2994
Country : US
Telephone Number : 757-251-0879
Fax Number : 984-220-9437
Provider Business Practice Location Address
First Line : 4360 SHORE DR STE 101
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23455-2994
Country : US
Telephone Number : 757-251-0879
Fax Number : 984-220-9437
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2008
Last Update Date : 01/16/2026

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