Provider Demographics
NPI:1255097655
Name:SMALL, NEIKA NICOLE (APRN)
Entity type:Individual
Prefix:MRS
First Name:NEIKA
Middle Name:NICOLE
Last Name:SMALL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11087 SW IVORY SPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-7711
Mailing Address - Country:US
Mailing Address - Phone:954-854-8838
Mailing Address - Fax:
Practice Address - Street 1:11087 SW IVORY SPRINGS LN
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-7711
Practice Address - Country:US
Practice Address - Phone:954-854-8838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-10
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11016330363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health