Provider Demographics
NPI:1467462226
Name:IGLESIAS, NIEVES (MD)
Entity type:Individual
Prefix:
First Name:NIEVES
Middle Name:
Last Name:IGLESIAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 LAKESHORE PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-4264
Mailing Address - Country:US
Mailing Address - Phone:803-329-3177
Mailing Address - Fax:803-329-3319
Practice Address - Street 1:448 LAKESHORE PKWY STE 110
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-4264
Practice Address - Country:US
Practice Address - Phone:803-329-3177
Practice Address - Fax:803-329-3319
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC159212084P0804X
FLME833712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL05132OtherBCBS OF FL
FL141512080OtherCHAMPUS
FL262894500Medicaid
FL05132ZMedicare PIN