Provider Demographics
NPI:1508367889
Name:NICHOLS, JESSICA D (ARNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:D
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7909 STONEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-1927
Mailing Address - Country:US
Mailing Address - Phone:256-303-5108
Mailing Address - Fax:256-303-5108
Practice Address - Street 1:1717 NORTH E STREET
Practice Address - Street 2:TOWER 3, SUITE 231
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501
Practice Address - Country:US
Practice Address - Phone:850-469-7975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9310016363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024076700Medicaid