Provider Demographics
NPI:1427017250
Name:NICHOLSON, WILLIAM B (CRNA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:B
Last Name:NICHOLSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:C/O ANESCO NORTH BROWARD LLC
Mailing Address - Street 2:3601 W COMMERCIAL BLVD STE 45
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309
Mailing Address - Country:US
Mailing Address - Phone:954-485-5666
Mailing Address - Fax:954-484-1651
Practice Address - Street 1:C/O IMPERIAL POINT MEDICAL CENTER
Practice Address - Street 2:6401 NORTH FEDERAL HIGHWAY
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306
Practice Address - Country:US
Practice Address - Phone:954-776-8500
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3182242367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG2673ZMedicare ID - Type Unspecified
FLR16392Medicare UPIN