Provider Demographics
NPI:1144497058
Name:NICHOLS, NANCY KAY
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:KAY
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:KAY
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:16910 S US HIGHWAY 441
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-8664
Mailing Address - Country:US
Mailing Address - Phone:352-347-4422
Mailing Address - Fax:352-347-9044
Practice Address - Street 1:16910 S US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-8664
Practice Address - Country:US
Practice Address - Phone:352-347-4422
Practice Address - Fax:352-347-9044
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA30425173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist