Provider Demographics
NPI:1336461912
Name:NICHOLS, INEZ H (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:INEZ
Middle Name:H
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 SW STONEGATE TER
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32024-3463
Mailing Address - Country:US
Mailing Address - Phone:386-719-7066
Mailing Address - Fax:386-719-7066
Practice Address - Street 1:221 SW STONEGATE TER
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32024-3463
Practice Address - Country:US
Practice Address - Phone:386-719-7066
Practice Address - Fax:386-719-7066
Is Sole Proprietor?:No
Enumeration Date:2010-02-23
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1850432363LF0000X
GARN096819363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1336461912OtherNPI
FL1336461912OtherNPI