Provider Demographics
NPI:1255722617
Name:NICKLE, STEVEN BRANDON (DO)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:BRANDON
Last Name:NICKLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:BRANDON
Other - Middle Name:
Other - Last Name:NICKLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:3200 S UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-2018
Mailing Address - Country:US
Mailing Address - Phone:954-262-4100
Mailing Address - Fax:954-262-3981
Practice Address - Street 1:2121 N 1700 W
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-8803
Practice Address - Country:US
Practice Address - Phone:801-773-4840
Practice Address - Fax:801-525-8151
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO3507207N00000X
UT10260137-1204207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology