Healthcare Provider Details

I. General information

NPI: 1568175917
Provider Name (Legal Business Name): NIKISHA ALEXIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2022
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7149 NW 88TH AVE
TAMARAC FL
33321-2555
US

IV. Provider business mailing address

410 NE 160TH TER
MIAMI FL
33162-4339
US

V. Phone/Fax

Practice location:
  • Phone: 954-751-3928
  • Fax:
Mailing address:
  • Phone: 305-467-9601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: