Provider Demographics
NPI:1023327764
Name:GATES, NIKI (RN, MSN, CRNA, APRN)
Entity type:Individual
Prefix:
First Name:NIKI
Middle Name:
Last Name:GATES
Suffix:
Gender:F
Credentials:RN, MSN, CRNA, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11019 SW CYPRESS BEND AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:FL
Mailing Address - Zip Code:34269-5906
Mailing Address - Country:US
Mailing Address - Phone:305-304-7758
Mailing Address - Fax:
Practice Address - Street 1:1261 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2219
Practice Address - Country:US
Practice Address - Phone:941-366-2360
Practice Address - Fax:941-366-3123
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY638751367500000X
OK76923367500000X
COC-APN.0001128-C-CRNA367500000X
FLARNP9268598367500000X
FLAPRN11017710367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered