Individual
JOHNATHAN TYLER NICHOLLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1111 E MCDOWELL RD, PHOENIX, AZ 85006-2612
(602) 839-2000
Mailing address
9424 W EATON RD, PHOENIX, AZ 85037-4274
(801) 808-2672
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
CRNA1494
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
390207
—
AZ
Enumeration date
12/12/2017
Last updated
01/30/2025
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