Healthcare Provider Details

I. General information

NPI: 1346514981
Provider Name (Legal Business Name): NICOLE DANIELLE JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 W 15TH ST
PANAMA CITY FL
32401-1366
US

IV. Provider business mailing address

2711 W 15TH ST
PANAMA CITY FL
32401-1366
US

V. Phone/Fax

Practice location:
  • Phone: 850-769-6001
  • Fax: 850-769-6003
Mailing address:
  • Phone: 850-769-6001
  • Fax: 850-769-6003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: