Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MD.40409 | AL |
Y | 207Q00000X | Family Doctor | ME137805 | FL |
N | 207QS0010X | Family Doctor - Sports Medicine | MD.40409 | AL |
NPI | 1104351626 |
---|---|
Provider Name | Dr. Nicholas Dalton Heathscott |
First Address | Fort Myers, FL 33901-9342 |
Second Address | Tampa, FL 33613-1244 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2017 |
Last Update Date | 02/08/2021 |