Provider Demographics
NPI:1760706345
Name:NIDZGORSKI, VICKI A (DENTAL HYGIENIST)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:A
Last Name:NIDZGORSKI
Suffix:
Gender:F
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:A
Other - Last Name:NURMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5135
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33675-5135
Mailing Address - Country:US
Mailing Address - Phone:813-330-7801
Mailing Address - Fax:813-276-2999
Practice Address - Street 1:1105 E KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-3511
Practice Address - Country:US
Practice Address - Phone:813-330-7801
Practice Address - Fax:813-276-2999
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH19889124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDH19889OtherLICENSE