Provider Demographics
NPI:1821415969
Name:NDUKA, NONYE
Entity Type:Individual
Prefix:
First Name:NONYE
Middle Name:
Last Name:NDUKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7655 COLLINS RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-6422
Mailing Address - Country:US
Mailing Address - Phone:904-379-3746
Mailing Address - Fax:904-379-5743
Practice Address - Street 1:7655 COLLINS RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-6422
Practice Address - Country:US
Practice Address - Phone:904-379-3746
Practice Address - Fax:904-379-5743
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12373376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator