Provider Demographics
NPI:1407076052
Name:NICKELL-OLM, SHARON ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:ANN
Last Name:NICKELL-OLM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME38621207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine