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Organization

KEVIN NICHOLSON LLC

Active
Other names
Doctor 2 Your Door
Organization subpart
No

Provider details

NPI number
Authorized official
DR. TANSYLA NICHOLSON MD (MEDICAL DIRECTOR)
(407) 545-9191
Entity
Organization

Contact information

Practice address
1674 PLEASANT HILL RD, KISSIMMEE, FL 34746-3954
(407) 545-9191
(407) 641-8918
Mailing address
PO BOX 407, LOUGHMAN, FL 33858-0407
(407) 545-9191

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME101521
FL
208D00000X
General Practice Physician
ME101521
FL

Other

Enumeration date
04/11/2013
Last updated
04/11/2013
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