Provider Demographics
NPI:1306422456
Name:SIMMONS, TANIKA (LPN)
Entity type:Individual
Prefix:
First Name:TANIKA
Middle Name:
Last Name:SIMMONS
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 1:144 MERCHANT ST APT 100
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3785
Mailing Address - Country:US
Mailing Address - Phone:513-954-6954
Mailing Address - Fax:
Practice Address - Street 1:1312 1ST AVE APT B
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-4129
Practice Address - Country:US
Practice Address - Phone:513-954-6954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401482900113376K00000X
OHLPN.185051.MED-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No376K00000XNursing Service Related ProvidersNurse's Aide