Provider Demographics
NPI:1437955176
Name:SMITH, NICOLE R (LPN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:R
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:R
Other - Last Name:WESTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19228 NW COUNTY ROAD 12
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:FL
Mailing Address - Zip Code:32321-4102
Mailing Address - Country:US
Mailing Address - Phone:850-544-6459
Mailing Address - Fax:
Practice Address - Street 1:19228 NW COUNTY ROAD 12
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:FL
Practice Address - Zip Code:32321-4102
Practice Address - Country:US
Practice Address - Phone:850-544-6459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5265905251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care