Individual
KAITLIN ELAINE NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
5598 SUNRISE DR, FORT MYERS, FL 33919-1716
(239) 274-6749
(239) 274-6787
Mailing address
5598 SUNRISE DR APT 208, FORT MYERS, FL 33919-1716
(757) 651-6262
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AL5015
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AL5015
FLORIDA DEPARTMENT OF HEALTH AT LICENSURE
FL
Enumeration date
04/30/2018
Last updated
04/30/2018
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