Provider Demographics
NPI:1225278138
Name:HA, NIKKI (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:NIKKI
Middle Name:
Last Name:HA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 SANDCREEK RODA, SUITE A
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513
Mailing Address - Country:US
Mailing Address - Phone:877-905-4545
Mailing Address - Fax:
Practice Address - Street 1:597 CENTER AVE STE 150
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4674
Practice Address - Country:US
Practice Address - Phone:925-812-5317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP18682363LF0000X
HIAPRN-1251363LF0000X
HIAPRN-RX296363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily