Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | MA31371 | FL |
NPI | 1164744298 |
---|---|
Provider Name | Tamika T. Johnson |
First Address | Tamarac, FL 33321-4107 |
Second Address | Tamarac, FL 33321-4107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2010 |
Last Update Date | 16/02/2010 |