Provider Demographics
NPI:1699314393
Name:SCOTT, TAMIKA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:TAMIKA
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7120 MINSTREL WAY STE 106
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5274
Mailing Address - Country:US
Mailing Address - Phone:410-290-9191
Mailing Address - Fax:410-290-7330
Practice Address - Street 1:7120 MINSTREL WAY STE 106
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5274
Practice Address - Country:US
Practice Address - Phone:410-290-9191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-27
Last Update Date:2021-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR202138363LP2300X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care