Provider Demographics
NPI:1114355708
Name:SHARON NICKELL-OLM M D FAMILY MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:SHARON NICKELL-OLM M D FAMILY MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:NICKELL-OLM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-357-2600
Mailing Address - Street 1:2000 PREVATT ST
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-6149
Mailing Address - Country:US
Mailing Address - Phone:352-357-2600
Mailing Address - Fax:352-357-3400
Practice Address - Street 1:2000 PREVATT ST
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6149
Practice Address - Country:US
Practice Address - Phone:352-357-2600
Practice Address - Fax:352-357-3400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-17
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty