Provider Demographics
NPI:1801946041
Name:NICHOLLS, DEBORAH (ARNP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:NICHOLLS
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 1:4252 WOODBINE RD
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-8703
Mailing Address - Country:US
Mailing Address - Phone:850-994-2733
Mailing Address - Fax:850-994-9987
Practice Address - Street 1:4252 WOODBINE RD
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-8703
Practice Address - Country:US
Practice Address - Phone:850-994-2733
Practice Address - Fax:850-994-9987
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9230907363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology