Healthcare Provider Details

I. General information

NPI: 1154758241
Provider Name (Legal Business Name): NIKKI MENDOZA PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 VINCENT BLVD
ALLIANCE OH
44601-3957
US

IV. Provider business mailing address

719 VINCENT BLVD
ALLIANCE OH
44601-3957
US

V. Phone/Fax

Practice location:
  • Phone: 614-930-2750
  • Fax: 614-930-2746
Mailing address:
  • Phone: 330-581-3280
  • Fax: 614-930-2746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0040815
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN.CNM.019407
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberARNP9352349
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: