Provider Demographics
NPI:1649208430
Name:PARILLA, NICK WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:NICK
Middle Name:WILLIAM
Last Name:PARILLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 DR MARTIN LUTHER KING JR ST N
Mailing Address - Street 2:STE. 108
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-1547
Mailing Address - Country:US
Mailing Address - Phone:727-456-4250
Mailing Address - Fax:727-346-1044
Practice Address - Street 1:1033 DR MARTIN LUTHER KING JR ST N
Practice Address - Street 2:STE. 108
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-1547
Practice Address - Country:US
Practice Address - Phone:727-456-4250
Practice Address - Fax:727-346-1044
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2372882080P0203X
FLME1022252080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02695196Medicaid
FLAM572ZOtherMEDICARE PTAN