Provider Demographics
NPI:1649256454
Name:KIKTA, EVELYN RUTH (ARNP)
Entity type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:RUTH
Last Name:KIKTA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:EVELYN
Other - Middle Name:RUTH
Other - Last Name:CARVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:212 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-3222
Mailing Address - Country:US
Mailing Address - Phone:727-422-4036
Mailing Address - Fax:806-243-4094
Practice Address - Street 1:212 HIGH ST
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-3222
Practice Address - Country:US
Practice Address - Phone:727-422-4036
Practice Address - Fax:806-243-4094
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1739202363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP1739202OtherMEDICAL LICENSE
FLP04019Medicare UPIN