Provider Demographics
NPI:1235535030
Name:NARIKKATTU, AGNES A
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:A
Last Name:NARIKKATTU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 NW 150TH AVE STE 278
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2885
Mailing Address - Country:US
Mailing Address - Phone:954-406-5220
Mailing Address - Fax:754-484-3904
Practice Address - Street 1:1931 NW 150TH AVE STE 278
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2885
Practice Address - Country:US
Practice Address - Phone:954-406-5220
Practice Address - Fax:754-484-3904
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-06
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9358568363LP0808X
FLARNP 9358568363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner