Provider Demographics
NPI:1891836227
Name:NICHOLS, JANE ANN (PT)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:ANN
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3269 SAN PEDRO ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3633
Mailing Address - Country:US
Mailing Address - Phone:727-791-1045
Mailing Address - Fax:
Practice Address - Street 1:3269 SAN PEDRO ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-3633
Practice Address - Country:US
Practice Address - Phone:727-791-1045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0018143225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist