Healthcare Provider Details

I. General information

NPI: 1790586188
Provider Name (Legal Business Name): NICOLE D JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15205 CARROLLTON BLVD
CARROLLTON VA
23314-2303
US

IV. Provider business mailing address

14334 BENNS CHURCH BLVD
SMITHFIELD VA
23430-6123
US

V. Phone/Fax

Practice location:
  • Phone: 757-745-7213
  • Fax: 757-257-1968
Mailing address:
  • Phone: 757-745-7213
  • Fax: 757-257-1968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: