Individual
MRS. CHANDA LEA NICOSIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CSFA/LSA
Contact information
Practice address
13674 ARIZONA DR, TYLER, TX 75707-6806
(903) 216-3561
(903) 566-6816
Mailing address
13674 ARIZONA DR, TYLER, TX 75707-6806
(903) 216-3561
(903) 566-6816
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
SA00471
TX
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
05/15/2008
Last updated
11/18/2015
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