Provider Demographics
NPI:1922997345
Name:LA ROSA, NIKKI (PHD)
Entity type:Individual
Prefix:DR
First Name:NIKKI
Middle Name:
Last Name:LA ROSA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:
Other - Last Name:LAROSA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:10418 TUPPER CAY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:FL
Mailing Address - Zip Code:33576-7414
Mailing Address - Country:US
Mailing Address - Phone:954-673-6019
Mailing Address - Fax:
Practice Address - Street 1:13000 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-4745
Practice Address - Country:US
Practice Address - Phone:813-300-2651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12792103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical