MEDICARE: NICOLE D SMITH LMT

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	225700000X	Massage Therapist	MA27835	FL

General Provider Information

NPI Number	:	1831468586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE D SMITH LMT

Provider Business Mailing Address
First Line	:	6015 CHESTER CIR STE 206
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2273
Country	:	US
Telephone Number	:	904-365-8305
Fax Number	:

Provider Business Practice Location Address
First Line	:	6015 CHESTER CIR STE 206
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2273
Country	:	US
Telephone Number	:	904-365-8305
Fax Number	:

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

Provider Enumeration Date	:	12/27/2011
Last Update Date	:	07/24/2019

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