Provider Demographics
NPI:1851040463
Name:FERRANDO, NICHOLAS
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:FERRANDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 2ND AVE S APT 1709
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4759
Mailing Address - Country:US
Mailing Address - Phone:814-450-6274
Mailing Address - Fax:
Practice Address - Street 1:5605 SKYTOP DR
Practice Address - Street 2:
Practice Address - City:LITHIA
Practice Address - State:FL
Practice Address - Zip Code:33547-4165
Practice Address - Country:US
Practice Address - Phone:813-737-7370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-21
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN277491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice