Provider Demographics
NPI:1437802204
Name:THOMAS SMITH, NICOLA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:NICOLA
Middle Name:
Last Name:THOMAS SMITH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LINTON BLVD STE 503A
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-3353
Mailing Address - Country:US
Mailing Address - Phone:561-265-5306
Mailing Address - Fax:561-265-5335
Practice Address - Street 1:6800 NW 7TH CT
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-4407
Practice Address - Country:US
Practice Address - Phone:954-608-3460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2019074270363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily