Provider Demographics
NPI:1720515851
Name:NICHOLS, STEVEN LAMAR (CSFA)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:LAMAR
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 S BROADWAY AVE APT 5312
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-7739
Mailing Address - Country:US
Mailing Address - Phone:863-934-4123
Mailing Address - Fax:
Practice Address - Street 1:806 NW 5TH ST
Practice Address - Street 2:
Practice Address - City:MULBERRY
Practice Address - State:FL
Practice Address - Zip Code:33860-2202
Practice Address - Country:US
Practice Address - Phone:863-934-4123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-19
Last Update Date:2023-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL167280246ZC0007X, 246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty