Provider Demographics
NPI:1134731169
Name:PEETE, TAMIKA (APRN)
Entity type:Individual
Prefix:MRS
First Name:TAMIKA
Middle Name:
Last Name:PEETE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 SE FLOWER MOUND RD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-6388
Mailing Address - Country:US
Mailing Address - Phone:405-123-4567
Mailing Address - Fax:
Practice Address - Street 1:501 SE FLOWER MOUND RD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-6388
Practice Address - Country:US
Practice Address - Phone:405-123-4567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK88586363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner