Justin Nichols

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

RN9488974 Issued in FL

Practice address

28 Ryding LN
Apt, Suite, Floor, Etc.
Palm Coast, FL 32164

Phone

(386) 517-3570

NPI assigned

Jan 9, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1673222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673222400000",
    "number": "1073227757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 RYDING LN",
            "address_2": "APT, SUITE, FLOOR, ETC.",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "32164",
            "telephone_number": "386-517-3570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 RYDING LN",
            "address_2": "APT, SUITE, FLOOR, ETC.",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "32164",
            "telephone_number": "386-517-3570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "JUSTIN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-01-09",
        "last_updated": "2023-01-09",
        "certification_date": "2023-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "FL",
            "license": "RN9488974",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "heartofcarrie.org",
            "affiliation": "Y",
            "endpointDescription": "website",
            "affiliationName": "Heart of Carrie LLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "17 Old Kings Rd N Ste E",
            "city": "Palm Coast",
            "state": "FL",
            "country_code": "US",
            "postal_code": "321378283",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Raphael NG, MD
• Marie M Ngalame, PHARM.D
• Andrew Nguyen
• Tennyson Nguyen, DMD
• Deanna Nichols, RN
• Heather S Niece, P.A.-C.
• Steven Kent Nieminen
• Nakia Nkansah, LPN
• Melissa Ada Noeth, DPT
• John Nolan

• Registered Nurse in Palm Coast, FL
• Providers in Palm Coast, FL by specialty
• Registered Nurse in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.