Provider Demographics
NPI:1194976860
Name:NIENKE, THOMAS (DO)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:NIENKE
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 1:5880 49TH ST N STE N-104
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-2150
Mailing Address - Country:US
Mailing Address - Phone:727-528-6100
Mailing Address - Fax:727-528-7895
Practice Address - Street 1:5880 49TH ST N STE N-104
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-2150
Practice Address - Country:US
Practice Address - Phone:727-528-6100
Practice Address - Fax:727-528-7895
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12013207XS0117X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHI139YOtherMEDICARE PTAN
FL008659300Medicaid
FL008659300Medicaid