Individual
NICOLE SHEMWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CERT HAIR LOSS SPECI
Contact information
Practice address
1021 OAK ST STE 129, JACKSONVILLE, FL 32204-3905
(904) 670-0906
Mailing address
7643 GATE PKWY STE 104-9023, JACKSONVILLE, FL 32256-3092
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
—
—
224900000X
Mastectomy Fitter
—
—
224P00000X
Prosthetist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BC3200X
Customized Equipment (DME)
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Enumeration date
12/27/2022
Last updated
04/01/2024
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