Provider Demographics
NPI:1851994586
Name:TOMSINE, NICKSON
Entity Type:Individual
Prefix:DR
First Name:NICKSON
Middle Name:
Last Name:TOMSINE
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 1:9095 AIRWAY DR APT 1524
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-3367
Mailing Address - Country:US
Mailing Address - Phone:954-226-2891
Mailing Address - Fax:
Practice Address - Street 1:1525 E NINE MILE RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-5725
Practice Address - Country:US
Practice Address - Phone:850-462-6528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS58218183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist