Provider Demographics
NPI:1932651528
Name:HAMMOND, TAMEKA NICOLE (ARNP)
Entity Type:Individual
Prefix:
First Name:TAMEKA
Middle Name:NICOLE
Last Name:HAMMOND
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5011 GATE PARKWAY
Mailing Address - Street 2:BLDG 100 STE 100
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4355
Mailing Address - Country:US
Mailing Address - Phone:904-512-7239
Mailing Address - Fax:866-380-0827
Practice Address - Street 1:5011 GATE PARKWAY
Practice Address - Street 2:BLDG 100 STE 100
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-4355
Practice Address - Country:US
Practice Address - Phone:904-512-7239
Practice Address - Fax:866-380-0827
Is Sole Proprietor?:No
Enumeration Date:2016-10-29
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9279524207R00000X, 208VP0014X
FLARNP9279524363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL202248493Medicaid