Provider Demographics
NPI:1043918451
Name:BALLET, TIKEYRA LACHELLE
Entity Type:Individual
Prefix:
First Name:TIKEYRA
Middle Name:LACHELLE
Last Name:BALLET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 NW 56TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34482-5148
Mailing Address - Country:US
Mailing Address - Phone:352-895-9984
Mailing Address - Fax:
Practice Address - Street 1:960 NW 56TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34482-5148
Practice Address - Country:US
Practice Address - Phone:352-895-9984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility