Individual
NICOLE FELICIA FELTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9267 CANARY IVY LN, JACKSONVILLE, FL 32219-6001
(904) 535-8218
Mailing address
9267 CANARY IVY LN, JACKSONVILLE, FL 32219-6001
(904) 535-8218
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203642802
—
FL
Enumeration date
08/01/2020
Last updated
08/01/2020
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