Provider Demographics
NPI:1366290504
Name:NDIACHI, NKEMNGONG ROSELINE (APRN)
Entity type:Individual
Prefix:
First Name:NKEMNGONG
Middle Name:ROSELINE
Last Name:NDIACHI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11125 N 52ND ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-2842
Mailing Address - Country:US
Mailing Address - Phone:813-453-3881
Mailing Address - Fax:
Practice Address - Street 1:11125 N 52ND ST
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-2842
Practice Address - Country:US
Practice Address - Phone:813-453-3881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11032442207LH0002X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No207LH0002XAllopathic & Osteopathic PhysiciansAnesthesiologyHospice and Palliative Medicine