Provider Demographics
NPI:1760796957
Name:NICHOLAS A HERRERO MD PLLC
Entity Type:Organization
Organization Name:NICHOLAS A HERRERO MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:HERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-272-3200
Mailing Address - Street 1:2035 PROFESSIONAL CENTER DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4492
Mailing Address - Country:US
Mailing Address - Phone:904-272-3200
Mailing Address - Fax:
Practice Address - Street 1:2035 PROFESSIONAL CENTER DR
Practice Address - Street 2:SUITE A
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4492
Practice Address - Country:US
Practice Address - Phone:904-272-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-30
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDL981AMedicare PIN