Provider Demographics
NPI:1336861681
Name:NICHOLS, NATASHA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20200 W DIXIE HWY STE 5G
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1919
Mailing Address - Country:US
Mailing Address - Phone:562-386-7122
Mailing Address - Fax:
Practice Address - Street 1:20200 W DIXIE HWY STE 5G
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33180-1919
Practice Address - Country:US
Practice Address - Phone:562-386-7122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2022045775363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily