Provider Demographics
NPI:1023058237
Name:OKESON, NICHOLAS Z (DO)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:Z
Last Name:OKESON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13787 BELCHER RD S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-4065
Mailing Address - Country:US
Mailing Address - Phone:727-535-9899
Mailing Address - Fax:727-535-2818
Practice Address - Street 1:13787 BELCHER RD S
Practice Address - Street 2:SUITE 100
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-4065
Practice Address - Country:US
Practice Address - Phone:727-535-9899
Practice Address - Fax:727-535-2818
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7320207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251576800Medicaid
FL57461Medicare ID - Type Unspecified
FL251576800Medicaid