Provider Demographics
NPI:1982285128
Name:NICHOLS, RUGILE (DO)
Entity type:Individual
Prefix:
First Name:RUGILE
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:RUGILE
Other - Middle Name:
Other - Last Name:RAMOSKAITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10800 BRIGHTON BAY BLVD NE APT 3104
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-3490
Mailing Address - Country:US
Mailing Address - Phone:815-272-5067
Mailing Address - Fax:
Practice Address - Street 1:8011 N HIMES AVE STE 4
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2700
Practice Address - Country:US
Practice Address - Phone:813-488-1414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS20472208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice