Provider Demographics
NPI:1255846812
Name:DEVITO, NIKKI A (PA-C)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:A
Last Name:DEVITO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2500 ENGLISH CREEK AVE STE 1202
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5597
Mailing Address - Country:US
Mailing Address - Phone:609-677-6000
Mailing Address - Fax:
Practice Address - Street 1:1 CONTINENTAL DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-2231
Practice Address - Country:US
Practice Address - Phone:717-361-0666
Practice Address - Fax:717-361-0202
Is Sole Proprietor?:No
Enumeration Date:2017-12-05
Last Update Date:2023-06-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA059412363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant