Provider Demographics
NPI:1457652760
Name:PATTERSON, TIKISHA SHARONE
Entity Type:Individual
Prefix:MS
First Name:TIKISHA
Middle Name:SHARONE
Last Name:PATTERSON
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 1:5400 NW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34482-5544
Mailing Address - Country:US
Mailing Address - Phone:352-622-9293
Mailing Address - Fax:352-622-9825
Practice Address - Street 1:5400 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34482-5544
Practice Address - Country:US
Practice Address - Phone:352-622-9293
Practice Address - Fax:352-622-9825
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL680969396Medicaid