Provider Demographics
NPI:1104351626
Name:HEATHSCOTT, NICHOLAS DALTON (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:DALTON
Last Name:HEATHSCOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:239-599-2612
Practice Address - Street 1:1907 S ALEXANDER ST STE 1
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33566-0921
Practice Address - Country:US
Practice Address - Phone:137-543-3448
Practice Address - Fax:813-754-3574
Is Sole Proprietor?:No
Enumeration Date:2017-04-21
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME137805207Q00000X, 207Q00000X
ALMD.40409207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine