Provider Demographics
NPI:1144083734
Name:DONALD, NAKIA REGINA
Entity type:Individual
Prefix:
First Name:NAKIA
Middle Name:REGINA
Last Name:DONALD
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 1:3058 HIGHWAY 162
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLTON
Mailing Address - State:FL
Mailing Address - Zip Code:32426-7236
Mailing Address - Country:US
Mailing Address - Phone:850-541-5633
Mailing Address - Fax:
Practice Address - Street 1:3058 HIGHWAY 162
Practice Address - Street 2:
Practice Address - City:CAMPBELLTON
Practice Address - State:FL
Practice Address - Zip Code:32426-7236
Practice Address - Country:US
Practice Address - Phone:850-541-5633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112472300Medicaid