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Anatoly
Anatoly
Nikolaev
Medical doctor
Port St. Lucie, United States
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Florida Health Care Practitioner Data Portal
Full name
Anatoly Nikolaev
Job Title
Medical Doctor
Location
Port St Lucie
LIC ID
152008
Current License Expiration Date
31/01/2025
Original Date
26/02/2021
Professional Rank Code
ME
Effective Date
26/02/2021
Board Action Indicator
N
License Status Description
CLEAR
License Active Status Description
ACTIVE
Country Description
ST.LUCIE
Practice Location Address Line 1
9530 2950 Cleveland Clinic Blvd
Practice Location Address City
WESTON
Practice Location Address State
FL
Practice Location Address Zipcode
33331
Mode Code
NICA Exempt
Prescribing Indicator
N
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