Provider Demographics
NPI:1770165532
Name:KHAALIQ, TOMEKA (LPN)
Entity type:Individual
Prefix:
First Name:TOMEKA
Middle Name:
Last Name:KHAALIQ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3581 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30337-2623
Mailing Address - Country:US
Mailing Address - Phone:678-937-6659
Mailing Address - Fax:678-550-9581
Practice Address - Street 1:3581 MAIN ST
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30337-2623
Practice Address - Country:US
Practice Address - Phone:678-937-6659
Practice Address - Fax:678-550-9581
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN084206164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse