Provider Demographics
NPI:1780387555
Name:REDDY, NIGAM A (APRN)
Entity type:Individual
Prefix:
First Name:NIGAM
Middle Name:A
Last Name:REDDY
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 E ROLLINS ST # 6
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-5502
Mailing Address - Country:US
Mailing Address - Phone:407-303-6729
Mailing Address - Fax:
Practice Address - Street 1:265 E ROLLINS ST # 6
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5502
Practice Address - Country:US
Practice Address - Phone:407-303-6729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11025386363LF0000X
FLAPRN11025386363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily