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NPI Code Detail

MEDICARE: NICOLE LEE WINTER PSY.D.

MEDICARE: NICOLE LEE WINTER PSY.D.
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
1103TC0700XClinical PsychologistPY9722FL

General Provider Information

NPI Number : 1578007118
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE LEE WINTER PSY.D.
Provider Business Mailing Address
First Line : PO BOX 748519
Second Line :
City : ATLANTA
State : GA
Zip : 30374-8519
Country : US
Telephone Number : 904-376-3800
Fax Number : 904-376-3998
Provider Business Practice Location Address
First Line : 98 NOCATEE VILLAGE DR
Second Line :
City : PONTE VEDRA BEACH
State : FL
Zip : 32081-6152
Country : US
Telephone Number : 904-376-3800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/16/2016
Last Update Date : 08/05/2022

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