Provider Demographics
NPI:1124544713
Name:MONROE, TIKISHA
Entity Type:Individual
Prefix:MISS
First Name:TIKISHA
Middle Name:
Last Name:MONROE
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 1:2783 NW 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311
Mailing Address - Country:US
Mailing Address - Phone:352-665-3014
Mailing Address - Fax:
Practice Address - Street 1:2783 NW 26TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-2009
Practice Address - Country:US
Practice Address - Phone:352-665-3014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No251E00000XAgenciesHome Health
No347C00000XTransportation ServicesPrivate Vehicle
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide
No385H00000XRespite Care FacilityRespite Care