Provider Demographics
NPI:1508441296
Name:ALSTON, NIKISHA NICOLE
Entity Type:Individual
Prefix:
First Name:NIKISHA
Middle Name:NICOLE
Last Name:ALSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 PLEASANT PL
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-2952
Mailing Address - Country:US
Mailing Address - Phone:919-247-8865
Mailing Address - Fax:863-937-6912
Practice Address - Street 1:1316 PLEASANT PL
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-2952
Practice Address - Country:US
Practice Address - Phone:919-247-8865
Practice Address - Fax:863-937-6912
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-14
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA290752376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide