MEDICARE: NIKKI MENDOZA PMHNP

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	367A00000X	Advanced Practice Midwife	APRN.CNM.019407	OH
2	367A00000X	Advanced Practice Midwife	ARNP9352349	FL
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN.CNP.0040815	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154758241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKKI MENDOZA PMHNP

Provider Business Mailing Address
First Line	:	719 VINCENT BLVD
Second Line	:
City	:	ALLIANCE
State	:	OH
Zip	:	44601-3957
Country	:	US
Telephone Number	:	330-581-3280
Fax Number	:	614-930-2746

Provider Business Practice Location Address
First Line	:	719 VINCENT BLVD
Second Line	:
City	:	ALLIANCE
State	:	OH
Zip	:	44601-3957
Country	:	US
Telephone Number	:	614-930-2750
Fax Number	:	614-930-2746

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

Provider Enumeration Date	:	10/03/2013
Last Update Date	:	02/02/2026

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