Provider Demographics
NPI:1356238877
Name:ADAMS, NICOLE (CPLC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:CPLC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:SAMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 BUSCH DR # 26528
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-5547
Mailing Address - Country:US
Mailing Address - Phone:904-595-7303
Mailing Address - Fax:
Practice Address - Street 1:P.O. BOX 26528
Practice Address - Street 2:#26528
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-3221
Practice Address - Country:US
Practice Address - Phone:904-595-7303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach