Healthcare Provider Details

I. General information

NPI: 1972195824
Provider Name (Legal Business Name): CHELSEA NICHON COLLECTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8005 FLEUR DE LIS DR
JACKSONVILLE FL
32277-0904
US

IV. Provider business mailing address

7632 SOUTHSIDE BLVD APT 144
JACKSONVILLE FL
32256-7075
US

V. Phone/Fax

Practice location:
  • Phone: 904-575-6208
  • Fax:
Mailing address:
  • Phone: 904-575-6208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name: CHELSEA NICHON SMITH
Title or Position: OWNER
Credential:
Phone: 904-575-6208