Provider Demographics
NPI:1841616489
Name:ROBBINS, TYKISE LAJUAN (FNP)
Entity type:Individual
Prefix:MRS
First Name:TYKISE
Middle Name:LAJUAN
Last Name:ROBBINS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:TYKISE
Other - Middle Name:LAJUAN
Other - Last Name:ROBBINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:12900 PARK PLAZA DR STE 150
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-9329
Mailing Address - Country:US
Mailing Address - Phone:562-977-4674
Mailing Address - Fax:
Practice Address - Street 1:2922 COVINGTON PIKE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-6007
Practice Address - Country:US
Practice Address - Phone:901-425-0200
Practice Address - Fax:901-213-9868
Is Sole Proprietor?:No
Enumeration Date:2014-03-06
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18495363LF0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program