Provider Demographics
NPI:1659839462
Name:THOMAS, NIKESHA
Entity Type:Individual
Prefix:
First Name:NIKESHA
Middle Name:
Last Name:THOMAS
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 1:4768 WOODVILLE HWY APT 1212
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32305-0960
Mailing Address - Country:US
Mailing Address - Phone:850-296-2436
Mailing Address - Fax:
Practice Address - Street 1:4768 WOODVILLE HWY APT 1212
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32305-0960
Practice Address - Country:US
Practice Address - Phone:850-559-3678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care