Healthcare Provider Details

I. General information

NPI: 1831949411
Provider Name (Legal Business Name): SHAMARA ADRANAH NICHOLS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD
GAINESVILLE FL
32608-1197
US

IV. Provider business mailing address

938 CAPITOL PKWY
JACKSONVILLE FL
32218-2991
US

V. Phone/Fax

Practice location:
  • Phone: 352-376-1611
  • Fax:
Mailing address:
  • Phone: 786-487-5480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW22820
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: