Individual
GEORGE EZZAT NICOLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CAA
Contact information
Practice address
52 UNDERWOOD ST, ORLANDO, FL 32806-1110
(321) 841-5210
Mailing address
279 TIGER LILY CT, ALTAMONTE SPRINGS, FL 32714-5842
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
577
FL
367H00000X
Anesthesiologist Assistant
75000154A
IN
367H00000X
Anesthesiologist Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1103779329
ANTHEM PTAN
IN
Enumeration date
06/02/2020
Last updated
01/15/2025
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