Provider Demographics
NPI:1114603198
Name:NICHOLS, WILLIAM LEON
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LEON
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750
Mailing Address - Country:US
Mailing Address - Phone:253-754-0204
Mailing Address - Fax:
Practice Address - Street 1:175 SHERIDAN AVE
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750
Practice Address - Country:US
Practice Address - Phone:253-754-0204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider