Provider Demographics
NPI:1811014913
Name:TICKETT, JAIME ALLISON (BS)
Entity Type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:ALLISON
Last Name:TICKETT
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2041 SCOTLAND DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-1338
Mailing Address - Country:US
Mailing Address - Phone:727-734-3192
Mailing Address - Fax:727-734-3192
Practice Address - Street 1:2951 TANGERINE TER
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-4040
Practice Address - Country:US
Practice Address - Phone:727-224-3800
Practice Address - Fax:727-734-3192
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL765652100Medicaid