Provider Demographics
NPI:1164744298
Name:JOHNSON, TAMIKA T (LMT)
Entity Type:Individual
Prefix:
First Name:TAMIKA
Middle Name:T
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5924 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-4107
Mailing Address - Country:US
Mailing Address - Phone:954-478-4883
Mailing Address - Fax:
Practice Address - Street 1:5924 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-4107
Practice Address - Country:US
Practice Address - Phone:954-478-4883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA31371175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath