Provider Demographics
NPI:1760007959
Name:NICHOL, LEANNE CRIST (CRDH)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:CRIST
Last Name:NICHOL
Suffix:
Gender:F
Credentials:CRDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6957 BOULDER RUN LOOP
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33545-4854
Mailing Address - Country:US
Mailing Address - Phone:813-997-5435
Mailing Address - Fax:
Practice Address - Street 1:6957 BOULDER RUN LOOP
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33545-4854
Practice Address - Country:US
Practice Address - Phone:813-997-5435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH22837124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDH22837OtherSTATE LICENSE