Provider Demographics
NPI:1033128152
Name:ERNST NICOLITZ MD PA
Entity Type:Organization
Organization Name:ERNST NICOLITZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERNST
Authorized Official - Middle Name:
Authorized Official - Last Name:NICOLITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-398-2720
Mailing Address - Street 1:7051 SOUTHPOINT PKWY
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8713
Mailing Address - Country:US
Mailing Address - Phone:904-398-2720
Mailing Address - Fax:904-483-5640
Practice Address - Street 1:7051 SOUTHPOINT PKWY
Practice Address - Street 2:3RD FLOOR
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8709
Practice Address - Country:US
Practice Address - Phone:904-398-2720
Practice Address - Fax:904-398-6408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME31869173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD52587Medicare UPIN
FLK1778Medicare ID - Type UnspecifiedGROUP PROVIDER ID