Provider Demographics
NPI:1376236257
Name:ABRAM, TANIKA NOREE
Entity Type:Individual
Prefix:
First Name:TANIKA
Middle Name:NOREE
Last Name:ABRAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TANIKA
Other - Middle Name:NOREE
Other - Last Name:BETTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1118 FOLKSTONE DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-8782
Mailing Address - Country:US
Mailing Address - Phone:412-609-3651
Mailing Address - Fax:
Practice Address - Street 1:801 W BAY DR STE 424
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3234
Practice Address - Country:US
Practice Address - Phone:813-942-6165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-29
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGAA-NP001740363LP0808X
FLRN9489139163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health