Provider Demographics
NPI:1346485232
Name:JOHNSON, TAMIKA (MA, ECG TECH,DIRECTO)
Entity Type:Individual
Prefix:
First Name:TAMIKA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, ECG TECH,DIRECTO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1634 CENTRAL PKWY
Mailing Address - Street 2:115
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-6904
Mailing Address - Country:US
Mailing Address - Phone:513-362-2700
Mailing Address - Fax:513-784-0812
Practice Address - Street 1:1634 CENTRAL PARKWAY
Practice Address - Street 2:
Practice Address - City:CINN
Practice Address - State:OH
Practice Address - Zip Code:45202-6904
Practice Address - Country:US
Practice Address - Phone:513-362-2700
Practice Address - Fax:513-784-0812
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1706305376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide