Provider Demographics
NPI:1184218331
Name:SHORTER, TAMIKA CAMILIA (CRNP)
Entity Type:Individual
Prefix:
First Name:TAMIKA
Middle Name:CAMILIA
Last Name:SHORTER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 M ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-1415
Mailing Address - Country:US
Mailing Address - Phone:202-296-9877
Mailing Address - Fax:
Practice Address - Street 1:2240 M ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1415
Practice Address - Country:US
Practice Address - Phone:202-296-9877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR182445363LF0000X
DCNP1060583363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily