Provider Demographics
NPI:1588470124
Name:BREWER, TAMIKA NICOLE (LPN, WSOC)
Entity type:Individual
Prefix:MS
First Name:TAMIKA
Middle Name:NICOLE
Last Name:BREWER
Suffix:
Gender:F
Credentials:LPN, WSOC
Other - Prefix:MRS
Other - First Name:TAMIKA
Other - Middle Name:NICOLE
Other - Last Name:KNIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4029 HEARTHSTONE PL
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-4020
Mailing Address - Country:US
Mailing Address - Phone:567-202-5218
Mailing Address - Fax:
Practice Address - Street 1:5650 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1519
Practice Address - Country:US
Practice Address - Phone:419-517-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH180689164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse