Provider Demographics
NPI:1508363730
Name:DERRICK, TENISHA RENEE
Entity Type:Individual
Prefix:
First Name:TENISHA
Middle Name:RENEE
Last Name:DERRICK
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 1:1363 CALVERT DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-6510
Mailing Address - Country:US
Mailing Address - Phone:469-835-0237
Mailing Address - Fax:
Practice Address - Street 1:1363 CALVERT DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-6510
Practice Address - Country:US
Practice Address - Phone:469-835-0237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant