Provider Demographics
NPI:1194586644
Name:COBB, NIKKI CARRERA (ARNP)
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:CARRERA
Last Name:COBB
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 MARBLE ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-1924
Mailing Address - Country:US
Mailing Address - Phone:727-269-8732
Mailing Address - Fax:
Practice Address - Street 1:1017 MARBLE ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-1924
Practice Address - Country:US
Practice Address - Phone:727-269-8732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11030713363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner