Individual
KIMBERLY A NICHOLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
9350 CAMELOT DR, FORT MYERS, FL 33919-7980
(239) 481-5437
(239) 481-0571
Mailing address
12730 NEW BRITTANY BLVD STE 602, FORT MYERS, FL 33907-4690
(239) 275-5522
(239) 275-4464
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME102851
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000607900
—
FL
01
—
93132
BCBS FLORIDA
FL
Enumeration date
01/10/2007
Last updated
08/21/2020
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