MEDICARE: NURSENIKKIP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1750035572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NURSENIKKIP

Provider Business Mailing Address
First Line	:	10034 KINGS CROSSING DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32219-7619
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10034 KINGS CROSSING DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32219-7619
Country	:	US
Telephone Number	:	904-380-1281
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. MERCEDES HARDIN
Credential	:
Telephone Number	:	904-380-1281

Provider Enumeration Date	:	02/10/2022
Last Update Date	:	02/10/2022

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