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NPI Code Detail

MEDICARE: SHANTA TAMIKA HOPSON APN

MEDICARE: SHANTA TAMIKA HOPSON APN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner209016322IL

General Provider Information

NPI Number : 1184134462
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANTA TAMIKA HOPSON APN
Provider Business Mailing Address
First Line : 1502 PARKVIEW AVE
Second Line :
City : ROCKFORD
State : IL
Zip : 61107-1821
Country : US
Telephone Number : 815-381-7250
Fax Number : 815-381-7251
Provider Business Practice Location Address
First Line : 1502 PARKVIEW AVE
Second Line :
City : ROCKFORD
State : IL
Zip : 61107-1821
Country : US
Telephone Number : 815-381-7250
Fax Number : 815-381-7251
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2017
Last Update Date : 02/14/2023

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