Provider Demographics
NPI:1700184603
Name:HAKIM-ACKERMAN, TAHIRAH A (RN)
Entity Type:Individual
Prefix:
First Name:TAHIRAH
Middle Name:A
Last Name:HAKIM-ACKERMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TAHIRAH
Other - Middle Name:A
Other - Last Name:HAKIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:133 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:WYANDANCH
Mailing Address - State:NY
Mailing Address - Zip Code:11798-2103
Mailing Address - Country:US
Mailing Address - Phone:631-671-3124
Mailing Address - Fax:
Practice Address - Street 1:133 N 22ND ST
Practice Address - Street 2:
Practice Address - City:WYANDANCH
Practice Address - State:NY
Practice Address - Zip Code:11798-2103
Practice Address - Country:US
Practice Address - Phone:631-671-3124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301490164W00000X
NY687357163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse