Provider Demographics
NPI:1114588894
Name:PHILLIPS, NAKESHA SHERINA
Entity Type:Individual
Prefix:
First Name:NAKESHA
Middle Name:SHERINA
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NAKESHA
Other - Middle Name:
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1828 18TH ST E
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-6429
Mailing Address - Country:US
Mailing Address - Phone:941-462-0727
Mailing Address - Fax:
Practice Address - Street 1:1828 18TH ST E
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-6429
Practice Address - Country:US
Practice Address - Phone:941-462-0727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion