Provider Demographics
NPI:1073017414
Name:JONES, NICHOLE OLIVIA (MA)
Entity Type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:OLIVIA
Last Name:JONES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:NICHOLE
Other - Middle Name:OLIVIA
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:12518 IVORY STONE LOOP
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-6739
Mailing Address - Country:US
Mailing Address - Phone:239-821-4103
Mailing Address - Fax:
Practice Address - Street 1:12518 IVORY STONE LOOP
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-6739
Practice Address - Country:US
Practice Address - Phone:239-821-4103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLJ520634876440101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health