Provider Demographics
NPI:1023845641
Name:NETTLES, TENIKA (FNP)
Entity type:Individual
Prefix:MS
First Name:TENIKA
Middle Name:
Last Name:NETTLES
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4477 W 118TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-2258
Mailing Address - Country:US
Mailing Address - Phone:323-684-4577
Mailing Address - Fax:
Practice Address - Street 1:4477 W 118TH ST STE 300
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2258
Practice Address - Country:US
Practice Address - Phone:323-684-4577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-17
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95032129363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily