Provider Demographics
NPI:1790939015
Name:MCNICHOL, TJ (MD)
Entity Type:Individual
Prefix:DR
First Name:TJ
Middle Name:
Last Name:MCNICHOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29116 RIVERGATE RUN
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-6546
Mailing Address - Country:US
Mailing Address - Phone:813-293-6009
Mailing Address - Fax:813-388-6650
Practice Address - Street 1:910 OLD CAMP RD STE 114
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-5605
Practice Address - Country:US
Practice Address - Phone:352-259-4322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100254208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice