Individual
NICOLE FRAZEE-STEWART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1885 S 14TH ST, FERNANDINA BEACH, FL 32034-3033
(904) 277-4449
(904) 277-4177
Mailing address
PO BOX 1609, CALLAHAN, FL 32011-1609
(904) 277-4449
(904) 277-4177
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA26233
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DO0550
MEDICARE RAILROAD
FL
01
—
Y907M
FLORIDA BLUE
FL
01
—
Y927Q
FLORIDA BLUE
FL
Enumeration date
01/21/2016
Last updated
01/21/2016
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