MEDICARE: KATISHA NICHOLAS APRN

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	363LF0000X	Family Nurse Practitioner	APRN11028750	FL

General Provider Information

NPI Number	:	1811776289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATISHA NICHOLAS APRN

Provider Business Mailing Address
First Line	:	4037 NW 86TH TER
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-9281
Country	:	US
Telephone Number	:	352-265-4357
Fax Number	:

Provider Business Practice Location Address
First Line	:	4037 NW 86TH TER
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-9281
Country	:	US
Telephone Number	:	352-265-4357
Fax Number	:

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

Provider Enumeration Date	:	09/26/2023
Last Update Date	:	08/24/2024

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