Provider Demographics
NPI:1356186621
Name:GRECO, NICHOLAS TODD
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:TODD
Last Name:GRECO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 4TH AVE N APT 2
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-3498
Mailing Address - Country:US
Mailing Address - Phone:561-255-6692
Mailing Address - Fax:
Practice Address - Street 1:409 4TH AVE N APT 2
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-3498
Practice Address - Country:US
Practice Address - Phone:561-255-6692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11033529363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health