Individual
CHANTAL MARIE NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
630 N MAIN ST, WILLISTON, FL 32696-1705
(352) 528-0587
(352) 528-4834
Mailing address
23343 NW COUNTY ROAD 236, HIGH SPRINGS, FL 32643-9669
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
APRN11005897
FL
363LF0000X
Family Nurse Practitioner
Primary
APRN11005897
FL
Other
Enumeration date
01/27/2020
Last updated
02/19/2020
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