Provider Demographics
NPI:1568424992
Name:NICHOLS, JOYCE WARD (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:WARD
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 1:5020 ROLAND RD
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571
Mailing Address - Country:US
Mailing Address - Phone:850-994-2797
Mailing Address - Fax:850-983-5215
Practice Address - Street 1:5527 STEWART STREET
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570
Practice Address - Country:US
Practice Address - Phone:850-983-5200
Practice Address - Fax:850-983-5215
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1479602363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL302708200Medicaid