Provider Demographics
NPI:1336540053
Name:NICITA, ZERILLDA KRISTA (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:ZERILLDA KRISTA
Middle Name:
Last Name:NICITA
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:
Other - Last Name:CALUAG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ACNP-BC
Mailing Address - Street 1:2333 BIDDLE AVE
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-4668
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2333 BIDDLE AVE
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-4668
Practice Address - Country:US
Practice Address - Phone:734-246-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704259985363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care