Provider Demographics
NPI:1124636154
Name:MIKELL, TAMRA COFFEE
Entity type:Individual
Prefix:
First Name:TAMRA
Middle Name:COFFEE
Last Name:MIKELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2875 TATE CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-8873
Mailing Address - Country:US
Mailing Address - Phone:904-258-9778
Mailing Address - Fax:
Practice Address - Street 1:2875 TATE CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-8873
Practice Address - Country:US
Practice Address - Phone:904-258-9778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty