Provider Demographics
NPI:1487026068
Name:DERRICK, NIKI LYNN (APRN)
Entity Type:Individual
Prefix:
First Name:NIKI
Middle Name:LYNN
Last Name:DERRICK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:NIKI
Other - Middle Name:LYNN
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5534 CORTEZ RD W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-2817
Mailing Address - Country:US
Mailing Address - Phone:941-757-2100
Mailing Address - Fax:941-757-2101
Practice Address - Street 1:5534 CORTEZ RD W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-2817
Practice Address - Country:US
Practice Address - Phone:941-757-2100
Practice Address - Fax:941-757-2101
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9205370363L00000X
FLAPRN9205370363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner