Provider Demographics
NPI:1518409341
Name:DUKES, NISHEA
Entity Type:Individual
Prefix:
First Name:NISHEA
Middle Name:
Last Name:DUKES
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 1:1908 HEARTLAND CIR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-5105
Mailing Address - Country:US
Mailing Address - Phone:813-750-2215
Mailing Address - Fax:
Practice Address - Street 1:1908 HEARTLAND CIR
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33594-5105
Practice Address - Country:US
Practice Address - Phone:813-750-2215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health