Provider Demographics
NPI:1649782657
Name:STARKS, TAMIKA SHAVON (TAMIKA SERVICE LLC)
Entity type:Individual
Prefix:MRS
First Name:TAMIKA
Middle Name:SHAVON
Last Name:STARKS
Suffix:
Gender:F
Credentials:TAMIKA SERVICE LLC
Other - Prefix:MRS
Other - First Name:TAMIKA
Other - Middle Name:SHAVON
Other - Last Name:STARKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4134 LEAKED AVENUE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224
Mailing Address - Country:US
Mailing Address - Phone:804-616-5473
Mailing Address - Fax:
Practice Address - Street 1:4134 LEAKED AVENUE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224
Practice Address - Country:US
Practice Address - Phone:804-616-5473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-31
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA347C00000X, 172A00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No347C00000XTransportation ServicesPrivate VehicleGroup - Single Specialty
No172A00000XOther Service ProvidersDriverGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA822907611OtherMEDICARE
VA822907611Medicaid