Provider Demographics
NPI:1831335538
Name:HOLLAND, TAMIKA PATRICE (LPN)
Entity type:Individual
Prefix:
First Name:TAMIKA
Middle Name:PATRICE
Last Name:HOLLAND
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 1:159 E 96TH ST
Mailing Address - Street 2:11C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-3546
Mailing Address - Country:US
Mailing Address - Phone:718-488-0100
Mailing Address - Fax:718-488-0128
Practice Address - Street 1:199 JAY ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1907
Practice Address - Country:US
Practice Address - Phone:718-488-0100
Practice Address - Fax:718-488-0128
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2778461164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse