Individual
DR. GERALD L NICKERSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
333 TAMIAMI TRL S STE 101, VENICE, FL 34285
(941) 375-3006
Mailing address
280 VILLORESI BLVD, NOKOMIS, FL 34275-1987
(337) 257-4454
(813) 406-5195
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
11047R
LA
208100000X
Physical Medicine & Rehabilitation Physician
Primary
ME95990
FL
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
11047R
LA
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
ME95990
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1999989
—
LA
05
—
277901300
—
FL
Enumeration date
07/18/2006
Last updated
12/15/2023
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