Provider Demographics
NPI:1215587530
Name:THOMAS, TANIKQA (TANIKQA)
Entity Type:Individual
Prefix:
First Name:TANIKQA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:TANIKQA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 TRAILVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-9355
Mailing Address - Country:US
Mailing Address - Phone:318-560-8081
Mailing Address - Fax:
Practice Address - Street 1:3320 TRAILVIEW CIR
Practice Address - Street 2:
Practice Address - City:HAUGHTON
Practice Address - State:LA
Practice Address - Zip Code:71037-9355
Practice Address - Country:US
Practice Address - Phone:318-560-8081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health