Provider Demographics
NPI:1699001610
Name:HEALY, NICHOLAS N (DO)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:N
Last Name:HEALY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DAVIS BLVD
Mailing Address - Street 2:SUITE 504
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3463
Mailing Address - Country:US
Mailing Address - Phone:813-627-5931
Mailing Address - Fax:
Practice Address - Street 1:1 DAVIS BLVD
Practice Address - Street 2:SUITE 504
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3463
Practice Address - Country:US
Practice Address - Phone:813-627-5931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11467207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine