Provider Demographics
NPI:1194398107
Name:FOSTER, TKA LLARISSA JOY (APRN)
Entity Type:Individual
Prefix:
First Name:TKA LLARISSA
Middle Name:JOY
Last Name:FOSTER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TKA LLARISSA
Other - Middle Name:JOY
Other - Last Name:NEMBHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3429 NW 44TH ST APT 104
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33309-4270
Mailing Address - Country:US
Mailing Address - Phone:754-245-3120
Mailing Address - Fax:
Practice Address - Street 1:3429 NW 44TH ST APT 104
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33309-4270
Practice Address - Country:US
Practice Address - Phone:754-245-3120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11014241363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care