Individual
NICHOLAS ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
525 NW PEACOCK BLVD, PORT ST LUCIE, FL 34986-2210
(352) 219-1575
Mailing address
9350 WICKHAM WAY, ORLANDO, FL 32836-5517
(407) 697-8804
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000035965
BOARD OF CERTIFICATION ATHLETIC TRAINING
—
Enumeration date
06/05/2019
Last updated
06/05/2019
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