Provider Demographics
NPI:1700544012
Name:SURRELL, TAMIKA
Entity Type:Individual
Prefix:MISS
First Name:TAMIKA
Middle Name:
Last Name:SURRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 ARDELLA AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44306-2540
Mailing Address - Country:US
Mailing Address - Phone:330-834-5686
Mailing Address - Fax:
Practice Address - Street 1:680 ARDELLA AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-2540
Practice Address - Country:US
Practice Address - Phone:330-834-5686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
296765663OtherHOME HEALTH AIDE