Provider Demographics
NPI:1639268857
Name:STROH, NICKOLAS ANTONY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:NICKOLAS
Middle Name:ANTONY
Last Name:STROH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6850 TPC DRIVE
Mailing Address - Street 2:116
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070
Mailing Address - Country:US
Mailing Address - Phone:972-838-1635
Mailing Address - Fax:972-838-1634
Practice Address - Street 1:230 S PRESTON ROAD
Practice Address - Street 2:30
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078
Practice Address - Country:US
Practice Address - Phone:972-838-1635
Practice Address - Fax:972-838-1634
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02788363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00935335OtherRAILROAD MEDICARE
TX835N12OtherBC/BS TEXAS - EFFECT. 02/01/211
TXP00935335OtherRAILROAD MEDICARE
TXTXB121236Medicare PIN