Provider Demographics
NPI:1427116706
Name:NOLTE, THOMAS CHARLES (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:CHARLES
Last Name:NOLTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4224 PENSACOLA AVE
Mailing Address - Street 2:BRECKENRIDGE
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-4126
Mailing Address - Country:US
Mailing Address - Phone:239-949-0960
Mailing Address - Fax:
Practice Address - Street 1:4224 PENSACOLA AVE
Practice Address - Street 2:BRECKENRIDGE
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-4126
Practice Address - Country:US
Practice Address - Phone:239-949-0960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ114212084P0800X, 2084P0802X
FLME 821022084P0800X, 2084P0802X
PAMD-073143-L2084P0800X
CAG862522084P0800X, 2084P0802X
PAMD-0731322084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAN9267089OtherDEA #
AZD0043Medicare UPIN