Healthcare Provider Details

I. General information

NPI: 1750734653
Provider Name (Legal Business Name): NAKIA NKANSAH LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2016
Last Update Date: 07/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 BALTIMORE LN
PALM COAST FL
32137-8850
US

IV. Provider business mailing address

PO BOX 782
BUNNELL FL
32110-0782
US

V. Phone/Fax

Practice location:
  • Phone: 386-538-8210
  • Fax:
Mailing address:
  • Phone: 386-538-8210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN 5151319
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: