Nicholas Mickelson LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

NICHOLAS MICKELSON LLC

Practice address

13612 W Hillsborough Ave
Tampa, FL 33635-9638

Phone

(813) 444-7502

NPI assigned

Dec 1, 2020

Organization subpart

No

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

Authorized official

Name

Mrs. Maisa Bicudo Mickelson

Title

Office Manager

Phone

(813) 616-9019

Specialties & licenses 1

Addresses

Other names 1

• Nova Dental Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nicholas K. Mickelson, DMD

  • General Practice Dentistry
  • Tampa, FL
  • NPI 1821441601
  NPD

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

{
    "created_epoch": "1606780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606780800000",
    "number": "1679178271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8805 RUSTIC TRAIL CT",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336351557",
            "telephone_number": "813-616-9019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13612 W HILLSBOROUGH AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336359638",
            "telephone_number": "813-444-7502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICHOLAS MICKELSON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-01",
        "last_updated": "2020-12-01",
        "certification_date": "2020-11-30",
        "status": "A",
        "authorized_official_last_name": "MICKELSON",
        "authorized_official_first_name": "MAISA",
        "authorized_official_middle_name": "BICUDO",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "813-616-9019",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nova Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nancy Carolina Nicaragua- Ferrante, M.ED., BCBA
• Lindsay Michelle Niccolai, PHD
• Chris Nicely
• Michelle Diane Nicely, P.A.- C.
• Nicholas Koehler, P.a.
• Dion Albert Nicholas, LMT
• Melissa Michelle Nicholas
• Michael John Nicholas, MD
• Rosemarie Nicholas, PA-C
• Marcia Montel Nicholls

• Dental Clinic/Center in Tampa, FL
• Providers in Tampa, FL by specialty
• Dental Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2020; 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.