Provider Demographics
NPI:1497047146
Name:THOMAS, TAMIKA TANIESIA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TAMIKA
Middle Name:TANIESIA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:TAMIKA
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:4336 DE REIMER AVENUE
Mailing Address - Street 2:4336 DE REIMER AVE
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466
Mailing Address - Country:US
Mailing Address - Phone:917-504-3763
Mailing Address - Fax:
Practice Address - Street 1:4336 DE REIMER AVE
Practice Address - Street 2:4336 DE REIMER AVE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-1820
Practice Address - Country:US
Practice Address - Phone:917-504-3763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2872581164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse