Individual
LESLIE CONNOR NICKELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1600 SW ARCHER RD, GAINESVILLE, FL 32610-3003
(352) 265-5911
(352) 265-5606
Mailing address
PO BOX 918025, ORLANDO, FL 32891-8025
(352) 265-5911
(352) 265-5606
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
E4472
AR
207P00000X
Emergency Medicine Physician
Primary
ME92428
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
277980300
—
FL
Enumeration date
04/05/2006
Last updated
10/27/2009
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