Provider Information for 1053032607
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LILYBEL NICHOLAS
Other Names:Former Name:LILYBEL GOMEZSex: Female
NPI: 1053032607
Last Updated: 2025-01-12
Certification Date: 2025-01-12
Certification Date: 2025-01-12
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1053032607 | ||||||||
| Enumeration Date | 2022-09-12 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 850 E LIME ST UNIT 851 TARPON SPRINGS, FL 34688-9737 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 850 E LIME ST UNIT 851 TARPON SPRINGS, FL 34688-9737 United States Phone: 727-304-3177 | Fax: | ||||||||
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