Provider Demographics
NPI:1932428737
Name:SOLEIMANI, NIKKI RAE (PA)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:RAE
Last Name:SOLEIMANI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:RAE
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3355 GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2426
Mailing Address - Country:US
Mailing Address - Phone:419-383-7100
Mailing Address - Fax:
Practice Address - Street 1:7071 W CENTRAL AVE
Practice Address - Street 2:SUITE C
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-2700
Practice Address - Country:US
Practice Address - Phone:419-843-1370
Practice Address - Fax:419-843-1362
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20382363A00000X
OH50003404363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI4975003Medicare PIN
OHH066950Medicare PIN
MIMI4975Medicare PIN