Nikitah Tankoh Fonbah

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

ARNP9333177 Issued in FL

Practice address

23186 Blue Star Hwy
Quincy, FL 32351-5173

Phone

(850) 875-6000

NPI assigned

Jul 13, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• DV3 Health, Inc.

  • Family Medicine Physician
  • Tallahassee, FL
  • NPI 1144941816
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1531440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531440000000",
    "number": "1679059679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3492 DAYLILY LN",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323085890",
            "telephone_number": "229-309-0286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23186 BLUE STAR HWY",
            "city": "QUINCY",
            "state": "FL",
            "postal_code": "323515173",
            "telephone_number": "850-875-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2626 Capital Medical Blvd",
            "address_purpose": "LOCATION",
            "city": "Tallahassee",
            "state": "FL",
            "postal_code": "323084499",
            "country_code": "US",
            "telephone_number": "850-325-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FONBAH",
        "first_name": "NIKITAH",
        "middle_name": "TANKOH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-13",
        "last_updated": "2018-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP9333177",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jarviesha Figgers-Robinson
• Kay V Finlaw, ARNP
• Libbie Denise Fletcher, RDH
• Florida Department of Health
• Florida Department of Health
• Lonnie Ford III, DC, CCPA
• Caron A Forehand, OWNER
• Fresh Start Health Care Services,Inc
• James A Fullerton, PTA
• Taylor C Fultineer

• All providers in Quincy, FL
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.