Provider Demographics
NPI:1346718004
Name:KIRK, LAKISHA (CNA)
Entity Type:Individual
Prefix:
First Name:LAKISHA
Middle Name:
Last Name:KIRK
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 31ST AVE E
Mailing Address - Street 2:B
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208
Mailing Address - Country:US
Mailing Address - Phone:941-704-2209
Mailing Address - Fax:
Practice Address - Street 1:2519 9TH AVE W APT 2
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-4846
Practice Address - Country:US
Practice Address - Phone:941-681-6200
Practice Address - Fax:941-241-1497
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-10
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3438493747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant