Provider Demographics
NPI:1760982318
Name:IKIMI, JUSTINA (NP)
Entity Type:Individual
Prefix:
First Name:JUSTINA
Middle Name:
Last Name:IKIMI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S PARK RD STE 200200S
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-8592
Mailing Address - Country:US
Mailing Address - Phone:866-986-2263
Mailing Address - Fax:866-986-2263
Practice Address - Street 1:200 S PARK RD STE 200
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8541
Practice Address - Country:US
Practice Address - Phone:866-986-2263
Practice Address - Fax:866-968-6339
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2023-11-15
Deactivation Date:2019-04-22
Deactivation Code:
Reactivation Date:2022-02-08
Provider Licenses
StateLicense IDTaxonomies
TX672715163WH0200X
NYF348931-01363LF0000X
TX1047607363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WH0200XNursing Service ProvidersRegistered NurseHome Health