Provider Demographics
NPI:1598164592
Name:ERICKSON, JAMI
Entity Type:Individual
Prefix:MS
First Name:JAMI
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JAMI
Other - Middle Name:LYNN
Other - Last Name:TANKISS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:IDC
Mailing Address - Street 1:3605 ASH ST
Mailing Address - Street 2:#15
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103
Mailing Address - Country:US
Mailing Address - Phone:904-894-3883
Mailing Address - Fax:
Practice Address - Street 1:USS DEWEY
Practice Address - Street 2:DDG 105
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96663-1303
Practice Address - Country:US
Practice Address - Phone:619-556-4613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider