Individual
MISS JEANELLA C NICOLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ALLIED HEALTH
Contact information
Practice address
790 CRESTA CIR, WEST PALM BEACH, FL 33413-1048
(561) 698-1416
Mailing address
790 CRESTA CIR, WEST PALM BEACH, FL 33413-1048
(561) 698-1416
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
J242423975880
DL
FL
Enumeration date
03/24/2022
Last updated
03/24/2022
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