Provider Demographics
NPI:1962765990
Name:PELTZ, NIKOMI LYNNE
Entity type:Individual
Prefix:
First Name:NIKOMI
Middle Name:LYNNE
Last Name:PELTZ
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 1:326 MELISSA RAY DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-4192
Mailing Address - Country:US
Mailing Address - Phone:615-631-6005
Mailing Address - Fax:
Practice Address - Street 1:326 MELISSA RAY DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-4192
Practice Address - Country:US
Practice Address - Phone:615-631-6005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula