Provider Demographics
NPI:1780331629
Name:NEHODA, KHRYSTYNA
Entity type:Individual
Prefix:
First Name:KHRYSTYNA
Middle Name:
Last Name:NEHODA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4376 FOX RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-4004
Mailing Address - Country:US
Mailing Address - Phone:786-536-0860
Mailing Address - Fax:
Practice Address - Street 1:4376 FOX RIDGE DR
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-4004
Practice Address - Country:US
Practice Address - Phone:786-536-0860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11018584363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner