Individual
NIKKI RAE DORTCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3030 W DR MARTIN LUTHER KING JR BLVD, TAMPA, FL 33607-6308
(813) 872-2929
Mailing address
7026 SUMMER HOLLY PL, RIVERVIEW, FL 33578-4952
(813) 468-5638
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN9417152
FL
363LN0005X
Critical Care Neonatal Nurse Practitioner
Primary
APRN11009680
FL
Other
Enumeration date
03/31/2019
Last updated
02/24/2021
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