Individual
ROBERT W NICKESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12901 BRUCE B DOWNS BLVD, TAMPA, FL 33612-4742
(813) 974-2201
Mailing address
PO BOX 917770, ORLANDO, FL 32891-7770
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME63183
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18473
BLUE CROSS BLUE SHIELD
FL
05
—
371971500
—
FL
Enumeration date
08/09/2006
Last updated
10/23/2009
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