Provider Demographics
NPI:1841216769
Name:NIKEL, LISA M (ARNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:NIKEL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7547 JACQUE RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7163
Mailing Address - Country:US
Mailing Address - Phone:727-862-8561
Mailing Address - Fax:727-861-1951
Practice Address - Street 1:7547 JACQUE RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7163
Practice Address - Country:US
Practice Address - Phone:727-862-8561
Practice Address - Fax:727-861-1951
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2879552363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP30383Medicare UPIN
FLE5455BMedicare ID - Type Unspecified