Provider Demographics
NPI:1538926605
Name:BROWN, NIKISHIA SHANTRELL
Entity type:Individual
Prefix:
First Name:NIKISHIA
Middle Name:SHANTRELL
Last Name:BROWN
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 1:2682 TUSCARORA TRAIL
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-3942
Mailing Address - Country:US
Mailing Address - Phone:229-406-0774
Mailing Address - Fax:
Practice Address - Street 1:1848 SAGA CT
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-3942
Practice Address - Country:US
Practice Address - Phone:229-406-0774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
FL374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No251E00000XAgenciesHome Health