Provider Demographics
NPI:1316714959
Name:MIMS, TOQUITA VINESHIA
Entity type:Individual
Prefix:MISS
First Name:TOQUITA
Middle Name:VINESHIA
Last Name:MIMS
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 1:1415 BENTLEY CT # 1415
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-7996
Mailing Address - Country:US
Mailing Address - Phone:803-842-1264
Mailing Address - Fax:
Practice Address - Street 1:1415 BENTLEY CT # 1415
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-7996
Practice Address - Country:US
Practice Address - Phone:803-842-1264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9992295376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide