Provider Demographics
NPI:1700191764
Name:BUCKNER, TOMIKA DANIELLE (LPN)
Entity Type:Individual
Prefix:MS
First Name:TOMIKA
Middle Name:DANIELLE
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 PINE LANE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511
Mailing Address - Country:US
Mailing Address - Phone:813-432-0901
Mailing Address - Fax:
Practice Address - Street 1:515 PINE LN
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-7816
Practice Address - Country:US
Practice Address - Phone:813-438-0901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-15
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.136152-M-IV164W00000X
FLPN5198048164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse