Individual
CHRISTY LYNN NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
2441 N 9TH AVE STE B, PENSACOLA, FL 32503-3989
(864) 907-8705
Mailing address
2211 INDA AVE., PENSACOLA, FL 32526
(864) 907-8705
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101440800
—
FL
Enumeration date
11/15/2018
Last updated
02/06/2020
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