Organization
NICOSIA ENTERPRISES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHANDA LEA NICOSIA LSA (OWNER)
(903) 566-6816
Entity
Organization
Contact information
Practice address
13674 ARIZONA DR, TYLER, TX 75707-6806
(903) 566-6816
(972) 268-6014
Mailing address
13674 ARIZONA DR, TYLER, TX 75707-6806
(903) 566-6816
(972) 268-6014
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
SA00471
TX
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
12/15/2013
Last updated
11/18/2015
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