Provider Demographics
NPI:1619516515
Name:CARROLL, NIKKI R (RDN, LD/N)
Entity Type:Individual
Prefix:MS
First Name:NIKKI
Middle Name:R
Last Name:CARROLL
Suffix:
Gender:F
Credentials:RDN, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12920 SUMMERFIELD CROSSING BLVD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-7210
Mailing Address - Country:US
Mailing Address - Phone:813-998-8600
Mailing Address - Fax:
Practice Address - Street 1:12920 SUMMERFIELD CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-7210
Practice Address - Country:US
Practice Address - Phone:813-998-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-26
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9198133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered