Provider Demographics
NPI:1740461342
Name:NICHOLS, JAMIN A (AP)
Entity type:Individual
Prefix:
First Name:JAMIN
Middle Name:A
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7855 S HWY A1A
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32951-3910
Mailing Address - Country:US
Mailing Address - Phone:321-759-9040
Mailing Address - Fax:
Practice Address - Street 1:2115 WAVERLY PL
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-5446
Practice Address - Country:US
Practice Address - Phone:321-759-9040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-25
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 1357171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist