Provider Demographics
NPI:1528540085
Name:SCROGGINS, NITOSHA (RN)
Entity Type:Individual
Prefix:
First Name:NITOSHA
Middle Name:
Last Name:SCROGGINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 MCMILLEN AVE
Mailing Address - Street 2:
Mailing Address - City:WOLFFORTH
Mailing Address - State:TX
Mailing Address - Zip Code:79382-3356
Mailing Address - Country:US
Mailing Address - Phone:806-500-6089
Mailing Address - Fax:
Practice Address - Street 1:406 MCMILLEN AVE
Practice Address - Street 2:
Practice Address - City:WOLFFORTH
Practice Address - State:TX
Practice Address - Zip Code:79382-3356
Practice Address - Country:US
Practice Address - Phone:806-500-6089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX738981163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX05Medicaid