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NPI Code Detail

MEDICARE: MRS. NIKIA LASHONDA PHILLIPS APRN CNM

MEDICARE: MRS. NIKIA LASHONDA PHILLIPS APRN CNM
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
1367A00000XAdvanced Practice MidwifeARNP9191977FL
2207Q00000XFamily Medicine PhysicianARNP9191977FL

Other Identifiers

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

General Provider Information

NPI Number : 1740510312
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NIKIA LASHONDA PHILLIPS APRN CNM
Provider Business Mailing Address
First Line : 1397 MEDICAL PARK BLVD STE 140
Second Line :
City : WELLINGTON
State : FL
Zip : 33414-3187
Country : US
Telephone Number : 561-508-3989
Fax Number : 561-631-8872
Provider Business Practice Location Address
First Line : 1397 MEDICAL PARK BLVD STE 140
Second Line :
City : WELLINGTON
State : FL
Zip : 33414-3187
Country : US
Telephone Number : 561-508-3989
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2010
Last Update Date : 10/05/2020

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