Provider Demographics
NPI:1750976205
Name:CANNON, AKIVIA DANMIKA (RN)
Entity type:Individual
Prefix:
First Name:AKIVIA
Middle Name:DANMIKA
Last Name:CANNON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8024 BIG PINE WAY
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-1136
Mailing Address - Country:US
Mailing Address - Phone:561-255-6152
Mailing Address - Fax:
Practice Address - Street 1:4020 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-3918
Practice Address - Country:US
Practice Address - Phone:855-859-8810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-06
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9361696163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator