Provider Demographics
NPI:1891036547
Name:FLAH, TINEKA JACKQUETTE (NURSE)
Entity Type:Individual
Prefix:
First Name:TINEKA
Middle Name:JACKQUETTE
Last Name:FLAH
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:TINEKA
Other - Middle Name:JACKQUETTE
Other - Last Name:SELLERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE
Mailing Address - Street 1:8015 36TH AVE N APT 319
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55427-1961
Mailing Address - Country:US
Mailing Address - Phone:612-598-3102
Mailing Address - Fax:763-544-1816
Practice Address - Street 1:8015 36TH AVE N APT 319
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55427-1961
Practice Address - Country:US
Practice Address - Phone:612-598-3102
Practice Address - Fax:763-544-1816
Is Sole Proprietor?:No
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL 060246-6164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse