Elizabeth Marie Nicklaus, CPO

Primary specialty

OrthotistTaxonomy code 222Z00000X

License

CPO05072

Practice address

509 Viking Dr Ste E
Virginia Beach, VA 23452-7323

Phone

(757) 275-8050

Fax

(888) 600-5328

NPI assigned

May 14, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Coastline Medical, Inc.

  • Prosthetic/Orthotic Supplier
  • Virginia Beach, VA
  • NPI 1902176563

  Orthotist

  NPD

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

{
    "created_epoch": "1715644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715644800000",
    "number": "1710736780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 VIKING DR STE E",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234527323",
            "telephone_number": "757-275-8050",
            "fax_number": "888-600-5328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 VIKING DR STE E",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234527323",
            "telephone_number": "757-275-8050",
            "fax_number": "888-600-5328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKLAUS",
        "first_name": "ELIZABETH",
        "middle_name": "MARIE",
        "credential": "CPO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-14",
        "last_updated": "2024-05-14",
        "certification_date": "2024-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224P00000X",
            "taxonomy_group": "",
            "desc": "Prosthetist",
            "state": null,
            "license": "CPO05072",
            "primary": false
        },
        {
            "code": "222Z00000X",
            "taxonomy_group": "",
            "desc": "Orthotist",
            "state": null,
            "license": "CPO05072",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sandra W Nichols, PHD, APRN, PMHNP-BC,
• Shanta Nichols
• Jayla A Nicholson
• Shadesia Nicholson, FNP-C
• Tad Nickerson, ATC
• Carroll John Nickle, D.O.
• Susann Nicol, SLP
• Emmanuella Nicolas
• Fevry Nicolas
• Jessica Nicolas

• Orthotist in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Orthotist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 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.