Provider Demographics
NPI:1386651990
Name:KIRK, NIKKI (ARNP)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:
Last Name:KIRK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5771 ROOSEVELT BLVD
Mailing Address - Street 2:THE HOSPICE OF THE FLORIDA SUNCOAST
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760
Mailing Address - Country:US
Mailing Address - Phone:727-586-4432
Mailing Address - Fax:727-523-3257
Practice Address - Street 1:5771 ROOSEVELT BLVD
Practice Address - Street 2:THE HOSPICE OF THE FLORIDA SUNCOAST
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760
Practice Address - Country:US
Practice Address - Phone:727-586-4432
Practice Address - Fax:727-523-3257
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9185967363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPIN E8915ZMedicare ID - Type Unspecified
P77721Medicare UPIN