Provider Demographics
NPI:1790281475
Name:NICHOLS, JOSHUA (DPM)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1866 BUFORD BLVD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4442
Mailing Address - Country:US
Mailing Address - Phone:580-878-6998
Mailing Address - Fax:850-656-0203
Practice Address - Street 1:1866 BUFORD BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4442
Practice Address - Country:US
Practice Address - Phone:850-878-6998
Practice Address - Fax:850-656-0203
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO4281213E00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program