Provider Demographics
NPI:1114404498
Name:NIBA, DERRICK F (RN)
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:F
Last Name:NIBA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 W LEDBETTER DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-4740
Mailing Address - Country:US
Mailing Address - Phone:972-680-0096
Mailing Address - Fax:972-680-8318
Practice Address - Street 1:2231 W LEDBETTER DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-4740
Practice Address - Country:US
Practice Address - Phone:972-680-0096
Practice Address - Fax:972-680-8318
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1062450163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology