Provider Demographics
NPI:1699357624
Name:EVERETT, TRANIKA
Entity Type:Individual
Prefix:
First Name:TRANIKA
Middle Name:
Last Name:EVERETT
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 1:15036 BALM ROAD
Mailing Address - Street 2:SUITE 434
Mailing Address - City:BALM
Mailing Address - State:FL
Mailing Address - Zip Code:33503
Mailing Address - Country:US
Mailing Address - Phone:813-393-0629
Mailing Address - Fax:
Practice Address - Street 1:15036 BALM ROAD
Practice Address - Street 2:434
Practice Address - City:BALM
Practice Address - State:FL
Practice Address - Zip Code:33503-3350
Practice Address - Country:US
Practice Address - Phone:813-393-0629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT44185183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician