Provider Demographics
NPI:1154532083
Name:NICHOLS, RONNIE C
Entity type:Individual
Prefix:MR
First Name:RONNIE
Middle Name:C
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 NW 43RD ST
Mailing Address - Street 2:SUITE E-3
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-8137
Mailing Address - Country:US
Mailing Address - Phone:352-378-5400
Mailing Address - Fax:352-378-6332
Practice Address - Street 1:3600 NW 43RD ST
Practice Address - Street 2:SUITE E-3
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-8137
Practice Address - Country:US
Practice Address - Phone:352-378-5400
Practice Address - Fax:352-378-6332
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA40953225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC2667OtherBCBS PROVIDER