MEDICARE: MRS. TONYA SMITH NICHOLS FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	5007925	NC
2	363L00000X	Nurse Practitioner	5007925	NC

General Provider Information

NPI Number	:	1366819807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TONYA SMITH NICHOLS FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 751803
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1803
Country	:	US
Telephone Number	:	336-719-6100
Fax Number	:

Provider Business Practice Location Address
First Line	:	509 N ELAM AVE STE 3E
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27403-1129
Country	:	US
Telephone Number	:	336-832-1970
Fax Number	:	336-832-1988

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2015
Last Update Date	:	04/13/2026

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