Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003207671 |
---|---|
Provider Name | Ms. Tamika Lane Gardner |
First Address | Tampa, FL 33604-3221 |
Second Address | Temple Terrace, FL 33617-1107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2015 |
Last Update Date | 18/02/2015 |