Healthcare Provider Details

I. General information

NPI: 1053676072
Provider Name (Legal Business Name): NICOLE K ARMSTRONG ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 07/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 SAN MARCO BLVD SUITE 102
JACKSONVILLE FL
32207-8568
US

IV. Provider business mailing address

1325 SAN MARCO BLVD SUITE 102
JACKSONVILLE FL
32207-8568
US

V. Phone/Fax

Practice location:
  • Phone: 904-858-7045
  • Fax: 904-858-7047
Mailing address:
  • Phone: 904-858-7045
  • Fax: 904-858-7047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL3104
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: