Provider Demographics
NPI:1922585405
Name:NICKOL, PATRICIA ANN (ITDS)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:NICKOL
Suffix:
Gender:F
Credentials:ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8988 79TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33777
Mailing Address - Country:US
Mailing Address - Phone:727-798-0417
Mailing Address - Fax:
Practice Address - Street 1:8988
Practice Address - Street 2:79TH AVE N
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33777
Practice Address - Country:US
Practice Address - Phone:727-798-0417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist