Provider Demographics
NPI:1750878930
Name:DERKITS, ERICA (CRNP)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:DERKITS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 WOODHAVEN RD UNIT 508
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-2756
Mailing Address - Country:US
Mailing Address - Phone:215-416-7527
Mailing Address - Fax:
Practice Address - Street 1:902 CLINT MOORE RD STE 227
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-2800
Practice Address - Country:US
Practice Address - Phone:561-241-6676
Practice Address - Fax:561-989-3665
Is Sole Proprietor?:No
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00799500363LF0000X
TXAPI37070363LF0000X
PASP018491363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily