Provider Demographics
NPI:1063774149
Name:GARCIA, NICHOLAS J (DO)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:J
Last Name:GARCIA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 PINE ST STE 111B
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-4457
Mailing Address - Country:US
Mailing Address - Phone:941-681-3333
Mailing Address - Fax:941-681-3335
Practice Address - Street 1:900 PINE ST STE 111B
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-4457
Practice Address - Country:US
Practice Address - Phone:941-681-3333
Practice Address - Fax:941-681-3335
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1152207Q00000X
FLOS15833207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine