Provider Demographics
NPI:1487411377
Name:GIDEON, NAKIESHA
Entity type:Individual
Prefix:
First Name:NAKIESHA
Middle Name:
Last Name:GIDEON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3692 EAGLE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-9132
Mailing Address - Country:US
Mailing Address - Phone:904-788-2377
Mailing Address - Fax:
Practice Address - Street 1:3692 EAGLE ROCK RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-9132
Practice Address - Country:US
Practice Address - Phone:904-788-2377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X, 376K00000X, 376J00000X
FL374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide