Provider Demographics
NPI:1073007282
Name:RICKETTS, MONTHIA ALLISON (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:MONTHIA
Middle Name:ALLISON
Last Name:RICKETTS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:MRS
Other - First Name:VERONICA
Other - Middle Name:MARIE
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:5841 NW 56TH PLACE
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319
Mailing Address - Country:US
Mailing Address - Phone:561-460-9295
Mailing Address - Fax:954-720-4563
Practice Address - Street 1:5841 NW 56TH PLACE
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319
Practice Address - Country:US
Practice Address - Phone:561-640-9295
Practice Address - Fax:954-720-4563
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9200440163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse