Individual
HOLLY ANN NUCKOLLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
12670 CREEKSIDE LANE, SUITE 202, FORT MYERS, FL 33919-8759
(239) 482-2663
(239) 482-7585
Mailing address
12670 CREEKSIDE LANE, SUITE 202, FORT MYERS, FL 33919-8759
(239) 482-2663
(239) 482-7585
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9104011
FL
Other
Enumeration date
11/17/2006
Last updated
01/02/2008
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