Provider Demographics
NPI:1528744992
Name:SIMMONS, TAMIKA
Entity type:Individual
Prefix:MS
First Name:TAMIKA
Middle Name:
Last Name:SIMMONS
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 1:18202 DALBY
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240-1730
Mailing Address - Country:US
Mailing Address - Phone:248-513-5925
Mailing Address - Fax:
Practice Address - Street 1:18202 DALBY
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48240-1730
Practice Address - Country:US
Practice Address - Phone:248-513-5925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No172A00000XOther Service ProvidersDriver