Provider Demographics
NPI:1477208288
Name:SOUTHERN, TONJAMEKA R (RN)
Entity Type:Individual
Prefix:MRS
First Name:TONJAMEKA
Middle Name:R
Last Name:SOUTHERN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4674 EMPIRE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-2191
Mailing Address - Country:US
Mailing Address - Phone:317-514-0857
Mailing Address - Fax:
Practice Address - Street 1:811 N MARKET ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202
Practice Address - Country:US
Practice Address - Phone:317-514-0857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9521589163W00000X, 207N00000X, 2083C0008X, 405300000X
173C00000X, 251J00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No173C00000XOther Service ProvidersReflexologist
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No2083C0008XAllopathic & Osteopathic PhysiciansPreventive MedicineClinical Informatics
No251J00000XAgenciesNursing Care
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No405300000XOther Service ProvidersPrevention Professional