Healthcare Provider Details

I. General information

NPI: 1366819807
Provider Name (Legal Business Name): TONYA SMITH NICHOLS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2015
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 N ELAM AVE STE 3E
GREENSBORO NC
27403-1129
US

IV. Provider business mailing address

PO BOX 751803
CHARLOTTE NC
28275-1803
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-1970
  • Fax: 336-832-1988
Mailing address:
  • Phone: 336-719-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5007925
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5007925
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: