Chantal Marie Nichols, NP is a medicare enrolled "Nurse Practitioner - Family" physician in Williston, Florida. Her current practice location is
630 N Main St, Williston, Florida. You can reach out to her office (for appointments etc.) via phone at
(352) 528-0587.
Chantal Marie Nichols is licensed to practice in Florida (license number APRN11005897) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1437780764.
Physician's Profile
| Full Name | Chantal Marie Nichols |
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| Gender | Female |
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| Speciality | Nurse Practitioner - Family |
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| Location | 630 N Main St, Williston, Florida |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1437780764
- Provider Enumeration Date: 01/27/2020
- Last Update Date: 02/19/2020
Medicare PECOS Information:
- PECOS PAC ID: 7416385067
- Enrollment ID: I20240819002485
Medical Identifiers
Medical identifiers for Chantal Marie Nichols such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1437780764 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207Q00000X | Family Medicine | APRN11005897 (Florida) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | APRN11005897 (Florida) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Chantal Marie Nichols allows following entities to bill medicare on her behalf.
| Entity Name | Innovative Infusions Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1811299944
PECOS PAC ID: 6608054044
Enrollment ID: O20110707000108 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Chantal Marie Nichols is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Chantal Marie Nichols, NP
23343 Nw County Road 236,
High Springs, FL 32643-9669
Ph: () - | Chantal Marie Nichols, NP
630 N Main St,
Williston, FL 32696-1705
Ph: (352) 528-0587 |
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