Provider Demographics
NPI:1417350273
Name:ROSS, NIKOLA ALEXIS (MS)
Entity Type:Individual
Prefix:MRS
First Name:NIKOLA
Middle Name:ALEXIS
Last Name:ROSS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:NIKOLA
Other - Middle Name:ALEXIS
Other - Last Name:TOWNEND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3491 GANDY BLVD N
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-2658
Mailing Address - Country:US
Mailing Address - Phone:727-547-0607
Mailing Address - Fax:
Practice Address - Street 1:3491 GANDY BLVD N
Practice Address - Street 2:SUITE 201
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-2658
Practice Address - Country:US
Practice Address - Phone:727-547-0607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 12721101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health