Provider Demographics
NPI:1245021203
Name:NIKITIN, JESSICA SERGEVNA (RRNA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:SERGEVNA
Last Name:NIKITIN
Suffix:
Gender:F
Credentials:RRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11314 MADELYNN DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-5873
Mailing Address - Country:US
Mailing Address - Phone:818-792-2984
Mailing Address - Fax:
Practice Address - Street 1:10501 FGCU BLVD S
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33965-6502
Practice Address - Country:US
Practice Address - Phone:239-590-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9523540163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine