Provider Demographics
NPI:1285198507
Name:JARRETT, TANIKA D (APRN)
Entity Type:Individual
Prefix:
First Name:TANIKA
Middle Name:D
Last Name:JARRETT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-2908
Mailing Address - Country:US
Mailing Address - Phone:870-336-1793
Mailing Address - Fax:870-336-1786
Practice Address - Street 1:249 S MAIN ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-2908
Practice Address - Country:US
Practice Address - Phone:870-336-1793
Practice Address - Fax:870-336-1786
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005966363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR232220758Medicaid