Individual
NICOLE EDIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
13000 SAWGRASS VILLAGE CIR STE 14, PONTE VEDRA, FL 32082-3078
(904) 881-7612
Mailing address
13000 SAWGRASS VILLAGE CIR STE 14, PONTE VEDRA, FL 32082-3078
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
31120
FL
Other
Enumeration date
07/11/2022
Last updated
07/11/2022
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