Provider Demographics
NPI:1982879201
Name:BISHKO, NICOLE MICHELLE (D O)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MICHELLE
Last Name:BISHKO
Suffix:
Gender:F
Credentials:D O
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:MICHELLE
Other - Last Name:KILLIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:8130 66TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-2111
Mailing Address - Country:US
Mailing Address - Phone:727-544-8300
Mailing Address - Fax:727-544-8366
Practice Address - Street 1:8130 66TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-2111
Practice Address - Country:US
Practice Address - Phone:727-544-8300
Practice Address - Fax:727-544-8366
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 9969207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine