MEDICARE: NICOLE ANN SUTTON LCSW

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
1	1041C0700X	Clinical Social Worker	SW24342	FL

General Provider Information

NPI Number	:	1770280695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE ANN SUTTON LCSW

Provider Business Mailing Address
First Line	:	1115 E GONZALEZ ST
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32503-6050
Country	:	US
Telephone Number	:	850-483-1145
Fax Number	:	850-483-1147

Provider Business Practice Location Address
First Line	:	1115 E GONZALEZ ST
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32503-6050
Country	:	US
Telephone Number	:	396-906-9062
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2023
Last Update Date	:	03/04/2026

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