Doctor Name: | BYRON NICHOLS |
NPI Number: | 1205248457 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | RNC, BC |
License Number: | RN2595232 |
Business Practice Address: | 1255 Golfview Ave Bartow, FL - 338306736 |
Business Phone Number: | 8635190575 |
Business Fax Number: | |
Mailing Address: | Po Box 1559, BARTOW |
State: | FL |
Postal Code: | 338311559 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 05/22/2014 |
NPI Last Update Date: | 01/28/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163WP0808X |
License Number: | RN2595232 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | Psych/Mental Health |
Taxonomy Definition: |