Lydia Patrice Nichols, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

PN964691 Issued in FL

Practice address

19451 S Tamiami TRL Ste 12
Fort Myers, FL 33908-4815

Phone

(786) 777-8741

NPI assigned

Feb 23, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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": "1708646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708646400000",
    "number": "1255197588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19451 S TAMIAMI TRL STE 12",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339084815",
            "telephone_number": "786-777-8741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19451 S TAMIAMI TRL STE 12",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339084815",
            "telephone_number": "786-777-8741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "LYDIA",
        "middle_name": "PATRICE",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-02-23",
        "last_updated": "2024-02-23",
        "certification_date": "2024-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "FL",
            "license": "PN964691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thuong Nguyen, OD
• Thy A Nguyen, O.D.
• Patricia Nicholas, D.P.M.
• Arielle Dominique Nichols, CNM
• John Lee Nichols
• Tyler Jackson Nichols
• Cameron Lee Nicholson, M.D.
• Kaitlin Elaine Nicholson, ATC
• Kimberly A Nicholson, MD
• Antonio Nickel, PA-C

• Licensed Practical Nurse in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Licensed Practical Nurse in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2024; 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.