Provider Demographics
NPI:1760992051
Name:KALOUDIS, NIKOLAS CHRIS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:NIKOLAS
Middle Name:CHRIS
Last Name:KALOUDIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6633 FOREST AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-2612
Mailing Address - Country:US
Mailing Address - Phone:727-724-8611
Mailing Address - Fax:727-724-0425
Practice Address - Street 1:6633 FOREST AVE STE 300
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-2612
Practice Address - Country:US
Practice Address - Phone:727-724-8611
Practice Address - Fax:727-724-0425
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021400363A00000X
FLPA9115335363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113965800Medicaid