Provider Demographics
NPI:1679925879
Name:HAVERICK, ERICKA N (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:ERICKA
Middle Name:N
Last Name:HAVERICK
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:ERICK
Other - Middle Name:NICHOLE
Other - Last Name:DEEMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-CNP
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-7399
Mailing Address - Fax:
Practice Address - Street 1:2121 KENNY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-3503
Practice Address - Country:US
Practice Address - Phone:614-293-7399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.019333363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0191568Medicaid
OHH531540Medicare PIN