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NPI Code Detail

MEDICARE: ERIN J NICHOLS RD

MEDICARE: ERIN J NICHOLS RD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian949250
2133V00000XRegistered Dietitian

General Provider Information

NPI Number : 1164603023
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIN J NICHOLS RD
Provider Business Mailing Address
First Line : 800 PRUDENTIAL DR
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-8211
Country : US
Telephone Number : 904-202-2063
Fax Number :
Provider Business Practice Location Address
First Line : 800 PRUDENTIAL DR
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-8211
Country : US
Telephone Number : 904-202-2063
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2007
Last Update Date : 05/31/2024

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