Provider Demographics
NPI:1922575737
Name:BEREZICH, NICHOLAS OLIVER (NP-C)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:OLIVER
Last Name:BEREZICH
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 N SAGINAW BLVD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:TX
Mailing Address - Zip Code:76179-5095
Mailing Address - Country:US
Mailing Address - Phone:817-847-6918
Mailing Address - Fax:
Practice Address - Street 1:1301 N SAGINAW BLVD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76179-5095
Practice Address - Country:US
Practice Address - Phone:817-847-6918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2022-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139345363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily