Provider Demographics
NPI:1518655471
Name:ELLIS, TAMIKA LAQUISHA (AH CPR/FIRSTAID CERT)
Entity Type:Individual
Prefix:
First Name:TAMIKA
Middle Name:LAQUISHA
Last Name:ELLIS
Suffix:
Gender:F
Credentials:AH CPR/FIRSTAID CERT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 CORPORATION LN STE 264
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BCH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3103
Mailing Address - Country:US
Mailing Address - Phone:703-214-5571
Mailing Address - Fax:
Practice Address - Street 1:2311 GOOD HOPE CT SE APT 102
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-3670
Practice Address - Country:US
Practice Address - Phone:703-214-5571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide