Provider Demographics
NPI:1316379100
Name:JERNIGAN, TAMANIKA
Entity Type:Individual
Prefix:
First Name:TAMANIKA
Middle Name:
Last Name:JERNIGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3840 N COMMERCE ST
Mailing Address - Street 2:STE. 100
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-8104
Mailing Address - Country:US
Mailing Address - Phone:702-649-5995
Mailing Address - Fax:
Practice Address - Street 1:3840 N COMMERCE ST
Practice Address - Street 2:STE. 100
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-8104
Practice Address - Country:US
Practice Address - Phone:702-649-5995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner