Provider Demographics
NPI:1619688348
Name:SALMON, NITA RAE
Entity Type:Individual
Prefix:MS
First Name:NITA
Middle Name:RAE
Last Name:SALMON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:NIKI
Other - Middle Name:
Other - Last Name:SALMON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:888 US HIGHWAY 441 SE
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34974-7422
Mailing Address - Country:US
Mailing Address - Phone:863-532-9096
Mailing Address - Fax:
Practice Address - Street 1:888 US HIGHWAY 441 SE
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34974-7422
Practice Address - Country:US
Practice Address - Phone:863-532-9096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility