Provider Demographics
NPI:1497485908
Name:NIENKE, ERIN JOAN (APRN)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:JOAN
Last Name:NIENKE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6730 22ND AVE N STE F
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-3903
Mailing Address - Country:US
Mailing Address - Phone:727-267-1136
Mailing Address - Fax:
Practice Address - Street 1:6730 22ND AVE N STE F
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-3903
Practice Address - Country:US
Practice Address - Phone:727-767-0168
Practice Address - Fax:727-245-8605
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11020136363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner