Provider Demographics
NPI:1124849922
Name:STARRWALKER, NIKKI
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:
Last Name:STARRWALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:FLAVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3712 NE 11TH PL
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-6457
Mailing Address - Country:US
Mailing Address - Phone:360-224-7451
Mailing Address - Fax:
Practice Address - Street 1:3850 WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-1921
Practice Address - Country:US
Practice Address - Phone:239-495-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9604802163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse