Provider Demographics
NPI:1043190523
Name:SMITH, NICHOLS JAMES (CRSS)
Entity type:Individual
Prefix:
First Name:NICHOLS
Middle Name:JAMES
Last Name:SMITH
Suffix:
Gender:M
Credentials:CRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 STOCKTON ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-2534
Mailing Address - Country:US
Mailing Address - Phone:904-387-4661
Mailing Address - Fax:
Practice Address - Street 1:555 STOCKTON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-2534
Practice Address - Country:US
Practice Address - Phone:904-387-4661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist