Healthcare Provider Details

I. General information

NPI: 1962306183
Provider Name (Legal Business Name): NICOLE ELIZABETH SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

1548 W BROAD ST
QUAKERTOWN PA
18951-1001
US

IV. Provider business mailing address

425 LEEDOM ST
JENKINTOWN PA
19046-2717
US

V. Phone/Fax

Practice location:
  • Phone: 315-491-3097
  • Fax:
Mailing address:
  • Phone: 315-491-3097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberSP037335
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: