IndividualActive
Jose Nicola, IDC
NPI 1205891256 · Independent Duty Corpsman · Great Lakes, IL
Provider details
- NPI number
- 1205891256
- Entity type
- Individual
- Primary specialty
- Independent Duty CorpsmanOther Service Providers
- Credential
- IDC
- Sex
- Male
- Sole proprietor
- No
Specialties & taxonomies
Other Service Providers
Practice location
Naval Health Clininc Great Lakes
Branch Medical Clinic 1007 Uss Tranquility
Great Lakes, IL 60088
Phone: (847) 688-2522
Approximate (ZIP-level) locationGet directions
Mailing address
907 Buccaneer Dr Apt a
Glenview, IL 60026-7047
Registry dates
- Enumerated
- 2006-04-20
- Last updated
- 2008-04-18
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.