MEDICARE: NIKEL S MYRICK

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	251E00000X	Home Health Agency		FL

General Provider Information

NPI Number	:	1144509159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKEL S MYRICK

Provider Business Mailing Address
First Line	:	3514 E 21ST AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33605-2243
Country	:	US
Telephone Number	:	813-295-0406
Fax Number	:

Provider Business Practice Location Address
First Line	:	3514 E 21ST AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33605-2243
Country	:	US
Telephone Number	:	813-295-0406
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2011
Last Update Date	:	12/15/2025

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