Provider Demographics
NPI:1073098836
Name:MIKE, SAMIKIA CLEOSHA
Entity Type:Individual
Prefix:
First Name:SAMIKIA
Middle Name:CLEOSHA
Last Name:MIKE
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 1:242 SAMUEL ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33897-6217
Mailing Address - Country:US
Mailing Address - Phone:863-412-0918
Mailing Address - Fax:
Practice Address - Street 1:242 SAMUEL ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33897-6217
Practice Address - Country:US
Practice Address - Phone:863-412-0918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)