Provider Demographics
NPI:1730499617
Name:FERRON, NICKESHIA (PA)
Entity Type:Individual
Prefix:MRS
First Name:NICKESHIA
Middle Name:
Last Name:FERRON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 BLOOMINGTON AVE UNIT 212
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-6493
Mailing Address - Country:US
Mailing Address - Phone:347-891-5958
Mailing Address - Fax:
Practice Address - Street 1:1207 E FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4513
Practice Address - Country:US
Practice Address - Phone:951-925-2523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21147363A00000X
FLPA9114525363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant