Provider Demographics
NPI:1487343794
Name:DANIELS, TAMEEKA DIANE
Entity type:Individual
Prefix:
First Name:TAMEEKA
Middle Name:DIANE
Last Name:DANIELS
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 1:9951 ATLANTIC BLVD STE 322
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-6577
Mailing Address - Country:US
Mailing Address - Phone:904-258-0264
Mailing Address - Fax:
Practice Address - Street 1:9951 ATLANTIC BLVD STE 322
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-6577
Practice Address - Country:US
Practice Address - Phone:904-792-2655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL342000000X
342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company