Provider Demographics
NPI:1902403082
Name:HERBERT, IKESHIA K
Entity Type:Individual
Prefix:
First Name:IKESHIA
Middle Name:K
Last Name:HERBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 ORANGE BLOSSOM DR
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-5075
Mailing Address - Country:US
Mailing Address - Phone:689-677-0870
Mailing Address - Fax:
Practice Address - Street 1:63 ORANGE BLOSSOM DR
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-5075
Practice Address - Country:US
Practice Address - Phone:689-677-0870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-02
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion