Provider Demographics
NPI:1659582724
Name:NICHOLS, JENNIFER LYNN (DO)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7300 SW 62ND PL FL 4
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4800
Mailing Address - Country:US
Mailing Address - Phone:321-752-0111
Mailing Address - Fax:321-752-0140
Practice Address - Street 1:8059 SPYGLASS HILL RD STE 102
Practice Address - Street 2:
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940-8566
Practice Address - Country:US
Practice Address - Phone:321-752-0111
Practice Address - Fax:321-752-0140
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS014387207V00000X
FLOS18799207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology