Provider Demographics
NPI:1780853218
Name:WILLIAMS, TAMIKA NICKCOLA (LMT)
Entity Type:Individual
Prefix:
First Name:TAMIKA
Middle Name:NICKCOLA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 WINKLER RD
Mailing Address - Street 2:STE. 1
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-7233
Mailing Address - Country:US
Mailing Address - Phone:239-810-0073
Mailing Address - Fax:239-542-7684
Practice Address - Street 1:6700 WINKLER RD
Practice Address - Street 2:STE. 1
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-7233
Practice Address - Country:US
Practice Address - Phone:239-810-0073
Practice Address - Fax:239-542-7684
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 43391225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist