Provider Demographics
NPI:1821539289
Name:NIKIA L. PHILLIPS, LLC
Entity Type:Organization
Organization Name:NIKIA L. PHILLIPS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:NIKIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-C, CNM
Authorized Official - Phone:561-508-3989
Mailing Address - Street 1:1397 MEDICAL PARK BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-3187
Mailing Address - Country:US
Mailing Address - Phone:561-508-3989
Mailing Address - Fax:561-631-8872
Practice Address - Street 1:1397 MEDICAL PARK BLVD STE 140
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-3187
Practice Address - Country:US
Practice Address - Phone:561-508-3989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-17
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9191977363LF0000X
FLCNM2261367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty