Provider Demographics
NPI:1740510312
Name:PHILLIPS, NIKIA LASHONDA (APRN CNM)
Entity type:Individual
Prefix:MRS
First Name:NIKIA
Middle Name:LASHONDA
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:APRN CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1397 MEDICAL PARK BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-3187
Mailing Address - Country:US
Mailing Address - Phone:561-508-3989
Mailing Address - Fax:561-631-8872
Practice Address - Street 1:1397 MEDICAL PARK BLVD STE 140
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-3187
Practice Address - Country:US
Practice Address - Phone:561-508-3989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9191977367A00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002001200Medicaid
FLHW680ZMedicare PIN