Provider Demographics
NPI:1154014389
Name:GHENT, NIKKIDA SHIREE (NP)
Entity type:Individual
Prefix:
First Name:NIKKIDA
Middle Name:SHIREE
Last Name:GHENT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6817 SOUTHPOINT PKWY STE 203
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6286
Mailing Address - Country:US
Mailing Address - Phone:904-256-9202
Mailing Address - Fax:
Practice Address - Street 1:6817 SOUTHPOINT PKWY STE 203
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6286
Practice Address - Country:US
Practice Address - Phone:904-256-9202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11026477363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner