Provider Demographics
NPI:1861729253
Name:BOBZIEN, NIKITTA ASHLEY (RT (R))
Entity type:Individual
Prefix:
First Name:NIKITTA
Middle Name:ASHLEY
Last Name:BOBZIEN
Suffix:
Gender:F
Credentials:RT (R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 MARRIOTT DR
Mailing Address - Street 2:#407
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32408-8018
Mailing Address - Country:US
Mailing Address - Phone:850-588-9631
Mailing Address - Fax:
Practice Address - Street 1:511 E 23RD ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-5307
Practice Address - Country:US
Practice Address - Phone:850-747-8822
Practice Address - Fax:850-747-8664
Is Sole Proprietor?:No
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCRT760732471C3402X
4617712471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography