Provider Demographics
NPI:1255197588
Name:NICHOLS, LYDIA PATRICE (LPN)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:PATRICE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19451 S TAMIAMI TRL STE 12
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-4815
Mailing Address - Country:US
Mailing Address - Phone:786-777-8741
Mailing Address - Fax:
Practice Address - Street 1:19451 S TAMIAMI TRL STE 12
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4815
Practice Address - Country:US
Practice Address - Phone:786-777-8741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN964691164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse