Provider Demographics
NPI:1013234277
Name:NICHOLS, TANYA A (RN CDE)
Entity Type:Individual
Prefix:MS
First Name:TANYA
Middle Name:A
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:RN CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4858 S CLASSICAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-1235
Mailing Address - Country:US
Mailing Address - Phone:561-637-8749
Mailing Address - Fax:561-803-8899
Practice Address - Street 1:5205 GREENWOOD AVE
Practice Address - Street 2:110
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2400
Practice Address - Country:US
Practice Address - Phone:561-803-8880
Practice Address - Fax:561-803-8899
Is Sole Proprietor?:No
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLRN9206105163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator