MEDICARE: ERIN NIKITAS

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	235Z00000X	Speech-Language Pathologist	SA18276	FL

General Provider Information

NPI Number	:	1407462765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN NIKITAS

Provider Business Mailing Address
First Line	:	3901 UNIVERSITY BLVD S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-4312
Country	:	US
Telephone Number	:	904-345-7251
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 UNIVERSITY BLVD W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2147
Country	:	US
Telephone Number	:	904-345-6780
Fax Number	:

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

Provider Enumeration Date	:	09/21/2020
Last Update Date	:	09/21/2020

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Directions to “ ERIN NIKITAS ” Practice Location

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