Provider Demographics
NPI:1134570930
Name:NICHOLAS, ANDREA (ARNP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:NICHOLAS
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:PO BOX 14669
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34280-4669
Mailing Address - Country:US
Mailing Address - Phone:941-999-2560
Mailing Address - Fax:941-209-5653
Practice Address - Street 1:209 82ND STREET
Practice Address - Street 2:
Practice Address - City:HOLMES BEACH
Practice Address - State:FL
Practice Address - Zip Code:34217
Practice Address - Country:US
Practice Address - Phone:941-545-1296
Practice Address - Fax:941-761-6580
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2854132363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health