Provider Demographics
NPI:1154758241
Name:MENDOZA, NIKKI (PMHNP)
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 VINCENT BLVD
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-3957
Mailing Address - Country:US
Mailing Address - Phone:330-581-3280
Mailing Address - Fax:
Practice Address - Street 1:719 VINCENT BLVD
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-3957
Practice Address - Country:US
Practice Address - Phone:614-930-2750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0040815363LP0808X
OHAPRN.CNM.019407367A00000X
FLARNP9352349367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife