Provider Demographics
NPI:1154078814
Name:COOKE, TAMIKA ALISHIA (AGPCNP-C)
Entity Type:Individual
Prefix:
First Name:TAMIKA
Middle Name:ALISHIA
Last Name:COOKE
Suffix:
Gender:F
Credentials:AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 824
Mailing Address - Street 2:
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440-0824
Mailing Address - Country:US
Mailing Address - Phone:863-254-7363
Mailing Address - Fax:
Practice Address - Street 1:1012 MISSISSIPPI AVE
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-5511
Practice Address - Country:US
Practice Address - Phone:863-254-7363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-03
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11018391363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology