MEDICARE: NICHELLE RENEE SMITH

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	376J00000X	Homemaker	240694	FL
2	372600000X	Adult Companion	240694	FL

General Provider Information

NPI Number	:	1942193008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHELLE RENEE SMITH

Provider Business Mailing Address
First Line	:	4733 FIRESIDE CT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-9307
Country	:	US
Telephone Number	:	904-651-6432
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 2543
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32203-2543
Country	:	US
Telephone Number	:	904-651-6432
Fax Number	:

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

Provider Enumeration Date	:	05/29/2025
Last Update Date	:	05/29/2025

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Directions to “ NICHELLE RENEE SMITH ” Practice Location

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